| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,703 |
892 |
$501K |
| D4341 |
|
6,825 |
1,687 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,204 |
821 |
$155K |
| D0210 |
Intraoral - complete series of radiographic images |
3,160 |
2,923 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,341 |
3,081 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,333 |
445 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,821 |
3,550 |
$71K |
| D1110 |
Prophylaxis - adult |
1,129 |
1,053 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,058 |
1,003 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,514 |
2,147 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
102 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
523 |
497 |
$14K |
| D4342 |
|
629 |
195 |
$12K |
| D4910 |
|
158 |
149 |
$7K |
| D0274 |
Bitewings - four radiographic images |
540 |
515 |
$6K |
| D1999 |
|
422 |
352 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,126 |
794 |
$2K |
| D0330 |
Panoramic radiographic image |
71 |
51 |
$521.41 |