| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,436 |
353 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
3,655 |
3,412 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
2,492 |
2,411 |
$73K |
| D1110 |
Prophylaxis - adult |
1,256 |
1,219 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
332 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,666 |
3,433 |
$59K |
| D1120 |
Prophylaxis - child |
1,654 |
1,572 |
$54K |
| D1351 |
Sealant - per tooth |
3,118 |
608 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
141 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
609 |
$30K |
| D0330 |
Panoramic radiographic image |
940 |
898 |
$28K |
| D0274 |
Bitewings - four radiographic images |
699 |
680 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,030 |
1,929 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,037 |
975 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
83 |
$13K |
| D7962 |
|
257 |
185 |
$13K |
| D4999 |
|
54 |
27 |
$8K |
| D7961 |
|
245 |
158 |
$7K |
| D9310 |
|
317 |
281 |
$6K |
| D7960 |
|
168 |
101 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
50 |
48 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$92.88 |
| D9986 |
|
147 |
142 |
$0.00 |
| D1354 |
|
554 |
87 |
$0.00 |