| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,424 |
527 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,128 |
1,253 |
$237K |
| D0210 |
Intraoral - complete series of radiographic images |
2,829 |
2,311 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,018 |
2,715 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,004 |
522 |
$93K |
| D1110 |
Prophylaxis - adult |
1,763 |
1,606 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,185 |
578 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,168 |
1,050 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,124 |
1,025 |
$26K |
| D0330 |
Panoramic radiographic image |
462 |
410 |
$20K |
| D1120 |
Prophylaxis - child |
651 |
602 |
$19K |
| D1206 |
Topical application of fluoride varnish |
826 |
764 |
$17K |
| D1351 |
Sealant - per tooth |
651 |
113 |
$17K |
| D0274 |
Bitewings - four radiographic images |
540 |
486 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,351 |
1,146 |
$14K |
| D2394 |
|
35 |
28 |
$4K |
| D2332 |
|
18 |
12 |
$2K |
| D2949 |
|
27 |
13 |
$2K |
| D4342 |
|
41 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
310 |
211 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$2K |
| D0270 |
|
12 |
12 |
$243.11 |