| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,909 |
1,475 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
8,677 |
8,365 |
$274K |
| D1110 |
Prophylaxis - adult |
4,619 |
4,467 |
$263K |
| D0140 |
Limited oral evaluation - problem focused |
5,391 |
5,075 |
$247K |
| D0272 |
Bitewings - two radiographic images |
9,097 |
8,785 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,386 |
1,306 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,908 |
1,257 |
$221K |
| D1120 |
Prophylaxis - child |
5,756 |
5,494 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,992 |
10,540 |
$206K |
| D1351 |
Sealant - per tooth |
4,667 |
1,237 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,473 |
1,414 |
$95K |
| D0330 |
Panoramic radiographic image |
1,676 |
1,638 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
6,325 |
5,898 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
347 |
210 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
24 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,466 |
1,166 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
24 |
$4K |
| D2940 |
|
34 |
29 |
$2K |
| D9986 |
|
47 |
46 |
$215.00 |