| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,475 |
2,274 |
$699K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,497 |
2,628 |
$406K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,841 |
1,419 |
$310K |
| D1110 |
Prophylaxis - adult |
6,481 |
6,081 |
$299K |
| D1351 |
Sealant - per tooth |
11,349 |
1,846 |
$272K |
| D0274 |
Bitewings - four radiographic images |
7,413 |
6,918 |
$250K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,121 |
2,065 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,882 |
5,516 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,621 |
1,097 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
6,341 |
5,986 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
9,148 |
8,458 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,287 |
4,976 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,723 |
7,188 |
$101K |
| D1120 |
Prophylaxis - child |
2,787 |
2,639 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,288 |
2,079 |
$78K |
| D4346 |
|
386 |
357 |
$77K |
| D2335 |
|
310 |
153 |
$54K |
| D2394 |
|
335 |
252 |
$39K |
| D0330 |
Panoramic radiographic image |
907 |
807 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
2,607 |
1,100 |
$27K |
| D2332 |
|
239 |
142 |
$25K |
| D4341 |
|
181 |
48 |
$20K |
| D1354 |
|
201 |
30 |
$12K |
| D0272 |
Bitewings - two radiographic images |
453 |
428 |
$8K |
| D2331 |
|
15 |
13 |
$2K |
| D2330 |
|
18 |
12 |
$2K |
| D0270 |
|
39 |
38 |
$616.93 |