| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,321 |
1,768 |
$475K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,348 |
1,585 |
$244K |
| D4355 |
|
3,381 |
3,271 |
$225K |
| D0330 |
Panoramic radiographic image |
3,099 |
2,982 |
$173K |
| D0140 |
Limited oral evaluation - problem focused |
4,642 |
4,336 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,425 |
3,297 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,227 |
5,441 |
$135K |
| D0274 |
Bitewings - four radiographic images |
4,217 |
4,102 |
$134K |
| D1110 |
Prophylaxis - adult |
3,416 |
3,366 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
966 |
711 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
7,465 |
7,138 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,334 |
4,268 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,054 |
748 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,500 |
3,424 |
$55K |
| D7250 |
|
314 |
128 |
$35K |
| D2335 |
|
260 |
170 |
$32K |
| D4341 |
|
292 |
122 |
$27K |
| D5110 |
|
49 |
41 |
$24K |
| D2332 |
|
206 |
148 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
108 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
149 |
$11K |
| D1120 |
Prophylaxis - child |
223 |
213 |
$6K |
| D2331 |
|
72 |
50 |
$6K |
| D1351 |
Sealant - per tooth |
139 |
29 |
$4K |
| D2394 |
|
15 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
108 |
106 |
$2K |
| D2330 |
|
16 |
12 |
$1K |