| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,088 |
957 |
$758K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,945 |
839 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,554 |
1,060 |
$309K |
| D5214 |
|
218 |
218 |
$215K |
| D5213 |
|
124 |
124 |
$121K |
| D0330 |
Panoramic radiographic image |
2,303 |
2,195 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,664 |
2,502 |
$80K |
| D2394 |
|
417 |
227 |
$71K |
| D1110 |
Prophylaxis - adult |
1,250 |
1,201 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,582 |
3,443 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,734 |
1,657 |
$54K |
| D5130 |
|
54 |
54 |
$46K |
| D5110 |
|
57 |
57 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,411 |
2,310 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
620 |
309 |
$39K |
| D2332 |
|
324 |
140 |
$37K |
| D7310 |
|
223 |
70 |
$30K |
| D1120 |
Prophylaxis - child |
895 |
846 |
$27K |
| D5120 |
|
30 |
30 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
787 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,055 |
2,814 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
830 |
800 |
$17K |
| D2335 |
|
110 |
59 |
$14K |
| D5140 |
|
13 |
13 |
$11K |
| D5410 |
|
283 |
252 |
$10K |
| D0272 |
Bitewings - two radiographic images |
528 |
494 |
$9K |
| D5411 |
|
226 |
201 |
$8K |
| D1354 |
|
109 |
14 |
$8K |
| D2331 |
|
93 |
52 |
$8K |
| D0350 |
|
138 |
124 |
$4K |
| D1351 |
Sealant - per tooth |
144 |
37 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
31 |
$2K |
| D1320 |
|
29 |
29 |
$913.08 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$861.38 |
| D5422 |
|
14 |
14 |
$559.92 |