| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
925 |
385 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
964 |
335 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,394 |
1,029 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
207 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,149 |
1,035 |
$45K |
| D2394 |
|
274 |
117 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
98 |
$15K |
| D0330 |
Panoramic radiographic image |
330 |
288 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
332 |
295 |
$11K |
| D4341 |
|
148 |
35 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
714 |
633 |
$8K |
| D0274 |
Bitewings - four radiographic images |
227 |
205 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
294 |
272 |
$6K |
| D1351 |
Sealant - per tooth |
291 |
32 |
$5K |
| D1110 |
Prophylaxis - adult |
101 |
95 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
403 |
321 |
$4K |
| D1120 |
Prophylaxis - child |
107 |
100 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
87 |
80 |
$2K |
| D4346 |
|
18 |
17 |
$2K |