| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,501 |
2,024 |
$638K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,330 |
5,877 |
$251K |
| D1110 |
Prophylaxis - adult |
4,016 |
3,752 |
$208K |
| D0274 |
Bitewings - four radiographic images |
5,385 |
4,963 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,258 |
903 |
$196K |
| D4346 |
|
1,010 |
918 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,158 |
1,361 |
$180K |
| D0140 |
Limited oral evaluation - problem focused |
3,393 |
3,154 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,201 |
1,230 |
$140K |
| D1351 |
Sealant - per tooth |
4,800 |
697 |
$129K |
| D0330 |
Panoramic radiographic image |
2,353 |
2,168 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
2,281 |
1,653 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
7,332 |
6,614 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,084 |
2,882 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,964 |
5,509 |
$75K |
| D1206 |
Topical application of fluoride varnish |
2,883 |
2,703 |
$59K |
| D1120 |
Prophylaxis - child |
1,906 |
1,802 |
$55K |
| D1354 |
|
649 |
147 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
292 |
218 |
$28K |
| D7250 |
|
105 |
52 |
$22K |
| D4341 |
|
147 |
43 |
$19K |
| D2335 |
|
110 |
53 |
$17K |
| D0272 |
Bitewings - two radiographic images |
485 |
452 |
$11K |
| D2332 |
|
14 |
12 |
$2K |
| D1999 |
|
46 |
38 |
$30.00 |