| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,135 |
4,586 |
$810K |
| D0210 |
Intraoral - complete series of radiographic images |
11,766 |
11,107 |
$493K |
| D1351 |
Sealant - per tooth |
28,839 |
3,541 |
$468K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,565 |
4,319 |
$450K |
| D1110 |
Prophylaxis - adult |
12,468 |
11,892 |
$375K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,557 |
14,667 |
$320K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,289 |
3,541 |
$318K |
| D0330 |
Panoramic radiographic image |
6,503 |
6,160 |
$236K |
| D1120 |
Prophylaxis - child |
8,448 |
8,008 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,076 |
12,451 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,442 |
1,882 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
9,841 |
9,435 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
5,637 |
5,325 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,930 |
4,719 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,477 |
910 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,469 |
2,770 |
$35K |
| D2330 |
|
1,051 |
274 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,573 |
1,524 |
$13K |
| D4355 |
|
175 |
159 |
$10K |
| D3310 |
|
56 |
26 |
$9K |
| D5212 |
|
24 |
24 |
$8K |
| D2335 |
|
136 |
43 |
$5K |
| D4341 |
|
46 |
12 |
$2K |
| D2332 |
|
53 |
13 |
$2K |
| D2331 |
|
50 |
25 |
$2K |
| D2394 |
|
15 |
13 |
$2K |
| D7311 |
|
44 |
33 |
$919.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
152 |
144 |
$811.07 |