| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,395 |
619 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,971 |
1,410 |
$228K |
| D1110 |
Prophylaxis - adult |
3,168 |
3,024 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,669 |
3,526 |
$136K |
| D0274 |
Bitewings - four radiographic images |
3,568 |
3,435 |
$131K |
| D4346 |
|
589 |
568 |
$121K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,125 |
606 |
$115K |
| D1351 |
Sealant - per tooth |
2,979 |
471 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,752 |
2,629 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,810 |
3,494 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
954 |
547 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,249 |
4,012 |
$53K |
| D0330 |
Panoramic radiographic image |
1,036 |
989 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
3,972 |
1,591 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
556 |
183 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,805 |
1,724 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
955 |
870 |
$35K |
| D1120 |
Prophylaxis - child |
1,086 |
1,051 |
$35K |
| D2394 |
|
160 |
91 |
$22K |
| D2335 |
|
88 |
55 |
$14K |
| D1206 |
Topical application of fluoride varnish |
248 |
242 |
$6K |
| D7250 |
|
23 |
12 |
$4K |
| D2332 |
|
17 |
13 |
$2K |
| D2330 |
|
18 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
25 |
$802.19 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$387.03 |