| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,147 |
531 |
$111K |
| D4355 |
|
1,254 |
1,171 |
$75K |
| D1110 |
Prophylaxis - adult |
2,072 |
1,973 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,917 |
2,785 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,094 |
1,634 |
$35K |
| D0330 |
Panoramic radiographic image |
706 |
668 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,318 |
2,146 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
892 |
831 |
$29K |
| D2332 |
|
292 |
166 |
$26K |
| D0274 |
Bitewings - four radiographic images |
883 |
845 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
284 |
192 |
$24K |
| D1120 |
Prophylaxis - child |
818 |
780 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,326 |
1,261 |
$20K |
| D1351 |
Sealant - per tooth |
728 |
180 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
486 |
457 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
131 |
$18K |
| D2160 |
|
158 |
116 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
118 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
217 |
$15K |
| D2330 |
|
163 |
92 |
$10K |
| D2335 |
|
63 |
45 |
$7K |
| D5422 |
|
235 |
221 |
$7K |
| D5421 |
|
216 |
202 |
$6K |
| D0272 |
Bitewings - two radiographic images |
258 |
235 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
24 |
$4K |
| D2140 |
|
33 |
25 |
$2K |
| D5650 |
|
36 |
25 |
$2K |
| D2161 |
|
14 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
95 |
$1K |
| D5410 |
|
31 |
29 |
$889.22 |
| D1999 |
|
17 |
17 |
$0.00 |