| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,343 |
938 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
3,156 |
2,938 |
$109K |
| D8670 |
Periodic orthodontic treatment visit |
1,041 |
926 |
$87K |
| D1110 |
Prophylaxis - adult |
2,866 |
2,683 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,568 |
826 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,409 |
3,187 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,376 |
2,195 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,661 |
2,497 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
763 |
451 |
$39K |
| D2394 |
|
503 |
255 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,967 |
1,809 |
$31K |
| D1120 |
Prophylaxis - child |
1,118 |
1,040 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,502 |
1,416 |
$21K |
| D2335 |
|
308 |
95 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
599 |
191 |
$17K |
| D0330 |
Panoramic radiographic image |
491 |
457 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,350 |
1,215 |
$6K |
| D5110 |
|
12 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
97 |
$4K |
| D2332 |
|
75 |
25 |
$3K |
| D4355 |
|
62 |
60 |
$3K |
| D7230 |
|
37 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
166 |
161 |
$2K |
| D2954 |
|
13 |
12 |
$1K |
| D9110 |
|
44 |
43 |
$896.68 |
| D0340 |
|
18 |
12 |
$305.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
79 |
$214.77 |