| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,411 |
818 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,178 |
1,090 |
$293K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,515 |
953 |
$270K |
| D1110 |
Prophylaxis - adult |
1,625 |
1,579 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,055 |
1,911 |
$80K |
| D2332 |
|
426 |
220 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,815 |
1,760 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,308 |
2,184 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,216 |
1,872 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
187 |
$32K |
| D0274 |
Bitewings - four radiographic images |
475 |
460 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
235 |
$15K |
| D2394 |
|
75 |
50 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
250 |
$12K |
| D2335 |
|
48 |
26 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
440 |
425 |
$8K |
| D1120 |
Prophylaxis - child |
49 |
48 |
$2K |