| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,586 |
1,486 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
3,102 |
2,811 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,380 |
4,015 |
$123K |
| D0274 |
Bitewings - four radiographic images |
3,190 |
2,892 |
$63K |
| D1120 |
Prophylaxis - child |
1,361 |
1,263 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
5,261 |
4,574 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,819 |
1,574 |
$52K |
| D1110 |
Prophylaxis - adult |
2,101 |
1,845 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,196 |
4,093 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,996 |
1,784 |
$27K |
| D1206 |
Topical application of fluoride varnish |
929 |
855 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
578 |
199 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
186 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
757 |
696 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
97 |
$6K |
| D1351 |
Sealant - per tooth |
179 |
24 |
$4K |
| D0270 |
|
228 |
179 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
53 |
53 |
$2K |
| D9110 |
|
31 |
28 |
$748.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$300.00 |