| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,365 |
1,058 |
$357K |
| D0210 |
Intraoral - complete series of radiographic images |
3,502 |
3,460 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,495 |
1,352 |
$172K |
| D1351 |
Sealant - per tooth |
6,056 |
661 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,615 |
4,539 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,952 |
1,031 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,077 |
706 |
$91K |
| D4346 |
|
657 |
650 |
$61K |
| D4341 |
|
384 |
114 |
$37K |
| D4342 |
|
704 |
232 |
$32K |
| D1110 |
Prophylaxis - adult |
868 |
841 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,120 |
1,079 |
$26K |
| D0330 |
Panoramic radiographic image |
507 |
489 |
$23K |
| D1120 |
Prophylaxis - child |
755 |
750 |
$22K |
| D2332 |
|
275 |
176 |
$20K |
| D2330 |
|
301 |
146 |
$15K |
| D7311 |
|
214 |
147 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
818 |
798 |
$14K |
| D9110 |
|
446 |
401 |
$13K |
| D2394 |
|
138 |
102 |
$13K |
| D2335 |
|
132 |
70 |
$11K |
| D4355 |
|
115 |
105 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
51 |
$8K |
| D0274 |
Bitewings - four radiographic images |
435 |
427 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
809 |
795 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
322 |
318 |
$6K |
| D1206 |
Topical application of fluoride varnish |
325 |
322 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
604 |
570 |
$4K |
| D2331 |
|
43 |
29 |
$3K |