| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,523 |
707 |
$266K |
| D1351 |
Sealant - per tooth |
6,121 |
684 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,481 |
949 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,559 |
904 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,206 |
3,158 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,550 |
1,535 |
$99K |
| D0330 |
Panoramic radiographic image |
1,097 |
1,079 |
$89K |
| D1110 |
Prophylaxis - adult |
1,739 |
1,717 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
430 |
363 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,789 |
1,764 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,432 |
1,400 |
$28K |
| D1120 |
Prophylaxis - child |
561 |
556 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,318 |
1,258 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
59 |
$15K |
| D0274 |
Bitewings - four radiographic images |
446 |
441 |
$14K |
| D4341 |
|
146 |
49 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
481 |
475 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
167 |
$8K |
| D2330 |
|
64 |
46 |
$4K |
| D2394 |
|
29 |
29 |
$3K |
| D2332 |
|
36 |
25 |
$3K |
| D2331 |
|
40 |
28 |
$3K |
| D4346 |
|
28 |
27 |
$3K |