| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,572 |
462 |
$150K |
| D4341 |
|
713 |
363 |
$97K |
| D1351 |
Sealant - per tooth |
1,014 |
382 |
$49K |
| D1120 |
Prophylaxis - child |
830 |
820 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,140 |
1,121 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
808 |
799 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,056 |
1,041 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
777 |
$20K |
| D1110 |
Prophylaxis - adult |
393 |
391 |
$18K |
| D2750 |
|
64 |
46 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
177 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,262 |
2,209 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,072 |
1,842 |
$12K |
| D2950 |
|
170 |
129 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
429 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
103 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
58 |
$5K |
| D0330 |
Panoramic radiographic image |
184 |
178 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
30 |
$4K |
| D3310 |
|
13 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
200 |
199 |
$2K |
| D9110 |
|
29 |
29 |
$2K |
| D0270 |
|
259 |
256 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
45 |
$918.14 |