| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,726 |
1,924 |
$724K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,504 |
1,746 |
$311K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,398 |
2,078 |
$305K |
| D0274 |
Bitewings - four radiographic images |
5,471 |
5,154 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,651 |
4,371 |
$162K |
| D1110 |
Prophylaxis - adult |
3,391 |
3,184 |
$159K |
| D0330 |
Panoramic radiographic image |
1,997 |
1,820 |
$110K |
| D1351 |
Sealant - per tooth |
4,372 |
748 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,006 |
5,342 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
6,295 |
5,856 |
$77K |
| D2394 |
|
618 |
379 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,029 |
2,869 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
901 |
336 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,619 |
2,469 |
$53K |
| D4341 |
|
376 |
107 |
$47K |
| D1120 |
Prophylaxis - child |
1,492 |
1,432 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,076 |
1,003 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
2,628 |
1,299 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
239 |
$22K |
| D7250 |
|
97 |
40 |
$21K |
| D2335 |
|
97 |
51 |
$17K |
| D2332 |
|
134 |
66 |
$16K |
| D1354 |
|
159 |
31 |
$8K |