| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,527 |
1,031 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,137 |
1,541 |
$233K |
| D1110 |
Prophylaxis - adult |
3,481 |
3,456 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,342 |
3,312 |
$142K |
| D0330 |
Panoramic radiographic image |
3,093 |
3,063 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,638 |
966 |
$99K |
| D1206 |
Topical application of fluoride varnish |
4,241 |
4,211 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,245 |
2,156 |
$72K |
| D4341 |
|
1,374 |
374 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,986 |
3,959 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,370 |
4,227 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,232 |
1,230 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
369 |
293 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,056 |
2,772 |
$16K |
| D2331 |
|
95 |
64 |
$8K |
| D2332 |
|
56 |
39 |
$6K |
| D9110 |
|
88 |
85 |
$6K |
| D1120 |
Prophylaxis - child |
138 |
135 |
$3K |
| D2394 |
|
45 |
40 |
$3K |
| D2335 |
|
34 |
30 |
$2K |
| D1351 |
Sealant - per tooth |
73 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$587.41 |
| D0270 |
|
32 |
32 |
$269.76 |