| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,612 |
1,387 |
$578K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
737 |
275 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
3,896 |
3,730 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,317 |
2,301 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,679 |
4,476 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,339 |
3,398 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,951 |
1,922 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
532 |
253 |
$56K |
| D1354 |
|
499 |
38 |
$38K |
| D1110 |
Prophylaxis - adult |
767 |
739 |
$36K |
| D2394 |
|
91 |
38 |
$16K |
| D1206 |
Topical application of fluoride varnish |
611 |
582 |
$11K |
| D1320 |
|
302 |
254 |
$11K |
| D5226 |
|
15 |
15 |
$10K |
| D5225 |
|
13 |
13 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
29 |
$4K |
| D1120 |
Prophylaxis - child |
130 |
130 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
241 |
241 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
140 |
131 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$2K |
| D0603 |
|
16 |
14 |
$146.40 |