| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,874 |
950 |
$251K |
| D1110 |
Prophylaxis - adult |
3,483 |
3,248 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
4,064 |
3,636 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,434 |
2,271 |
$85K |
| D0330 |
Panoramic radiographic image |
896 |
872 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
421 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,707 |
1,574 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,821 |
1,505 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
822 |
444 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,146 |
2,712 |
$42K |
| D1120 |
Prophylaxis - child |
714 |
633 |
$31K |
| D7230 |
|
123 |
77 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
549 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
909 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
166 |
$11K |
| D4341 |
|
85 |
30 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
87 |
$10K |
| D2332 |
|
62 |
42 |
$5K |
| D1351 |
Sealant - per tooth |
122 |
40 |
$5K |
| D2331 |
|
39 |
26 |
$3K |
| D2335 |
|
23 |
15 |
$2K |
| D9110 |
|
43 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
46 |
44 |
$926.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$338.00 |