| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,275 |
871 |
$246K |
| D0210 |
Intraoral - complete series of radiographic images |
3,601 |
3,499 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,142 |
4,051 |
$113K |
| D1351 |
Sealant - per tooth |
4,189 |
497 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,214 |
602 |
$88K |
| D1110 |
Prophylaxis - adult |
2,071 |
2,031 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
724 |
382 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,406 |
2,364 |
$44K |
| D1120 |
Prophylaxis - child |
986 |
966 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
146 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
785 |
763 |
$17K |
| D0274 |
Bitewings - four radiographic images |
701 |
692 |
$16K |
| D4341 |
|
176 |
66 |
$14K |
| D0330 |
Panoramic radiographic image |
269 |
265 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
70 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
734 |
720 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
230 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
651 |
608 |
$5K |
| D2335 |
|
39 |
24 |
$4K |