| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,075 |
924 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,140 |
1,133 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
2,774 |
2,580 |
$130K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,184 |
685 |
$97K |
| D1110 |
Prophylaxis - adult |
2,628 |
2,463 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,472 |
3,242 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,440 |
685 |
$77K |
| D0330 |
Panoramic radiographic image |
1,838 |
1,669 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,299 |
3,965 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,196 |
2,018 |
$66K |
| D1351 |
Sealant - per tooth |
2,663 |
334 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,353 |
2,178 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,590 |
2,398 |
$52K |
| D4355 |
|
948 |
871 |
$50K |
| D1120 |
Prophylaxis - child |
1,194 |
1,103 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,580 |
1,462 |
$20K |
| D9110 |
|
309 |
288 |
$11K |
| D2335 |
|
87 |
42 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
40 |
$7K |
| D2394 |
|
50 |
30 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
466 |
374 |
$4K |
| D2954 |
|
30 |
27 |
$3K |
| D4346 |
|
28 |
28 |
$2K |
| D2332 |
|
28 |
15 |
$2K |
| D0170 |
|
54 |
54 |
$985.22 |