| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,210 |
346 |
$156K |
| D1120 |
Prophylaxis - child |
2,192 |
2,064 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,533 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,038 |
1,919 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,437 |
1,362 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
360 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
971 |
879 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
974 |
$16K |
| D0330 |
Panoramic radiographic image |
912 |
843 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
714 |
663 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
72 |
$9K |
| D0272 |
Bitewings - two radiographic images |
723 |
682 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
128 |
$6K |
| D1110 |
Prophylaxis - adult |
168 |
158 |
$6K |
| D4341 |
|
39 |
24 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
480 |
$3K |
| D1351 |
Sealant - per tooth |
34 |
15 |
$2K |
| D0270 |
|
90 |
85 |
$487.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
63 |
$243.20 |