| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,708 |
1,206 |
$254K |
| D0140 |
Limited oral evaluation - problem focused |
4,839 |
4,749 |
$203K |
| D0330 |
Panoramic radiographic image |
2,772 |
2,735 |
$176K |
| D1110 |
Prophylaxis - adult |
2,880 |
2,863 |
$171K |
| D1120 |
Prophylaxis - child |
2,677 |
2,666 |
$140K |
| D0272 |
Bitewings - two radiographic images |
4,862 |
4,837 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,598 |
4,577 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,863 |
3,847 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
5,461 |
5,212 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
823 |
514 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
818 |
473 |
$70K |
| D1351 |
Sealant - per tooth |
1,673 |
617 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,158 |
1,152 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
219 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,802 |
1,367 |
$24K |
| D2740 |
Crown - porcelain/ceramic |
12 |
12 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$6K |
| D9110 |
|
123 |
118 |
$4K |