| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12,172 |
2,955 |
$1.85M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,972 |
2,170 |
$1.25M |
| D7310 |
|
2,720 |
800 |
$462K |
| D1110 |
Prophylaxis - adult |
8,684 |
7,948 |
$402K |
| D5130 |
|
593 |
532 |
$260K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,579 |
2,217 |
$258K |
| D0330 |
Panoramic radiographic image |
6,011 |
5,474 |
$251K |
| D5140 |
|
488 |
423 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,601 |
5,133 |
$196K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,745 |
1,697 |
$150K |
| D0274 |
Bitewings - four radiographic images |
4,458 |
4,110 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
6,367 |
5,806 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
4,985 |
4,590 |
$121K |
| D5110 |
|
285 |
243 |
$90K |
| D2331 |
|
621 |
415 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,249 |
2,064 |
$40K |
| D2330 |
|
491 |
291 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,036 |
939 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
241 |
$30K |
| D1120 |
Prophylaxis - child |
916 |
834 |
$18K |
| D5120 |
|
56 |
52 |
$16K |
| D2332 |
|
20 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$511.75 |
| D1999 |
|
867 |
758 |
$110.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$24.81 |