| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,014 |
312 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,236 |
2,059 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,118 |
609 |
$89K |
| D0330 |
Panoramic radiographic image |
2,174 |
1,983 |
$85K |
| D4341 |
|
1,953 |
565 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
626 |
317 |
$75K |
| D2335 |
|
574 |
236 |
$72K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,151 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
960 |
412 |
$57K |
| D2332 |
|
491 |
224 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,290 |
1,191 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,279 |
2,957 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,439 |
2,266 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,600 |
1,513 |
$34K |
| D9110 |
|
205 |
190 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
417 |
408 |
$14K |
| D1351 |
Sealant - per tooth |
276 |
51 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,650 |
2,362 |
$6K |
| D1120 |
Prophylaxis - child |
115 |
110 |
$2K |