| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,190 |
355 |
$125K |
| D1351 |
Sealant - per tooth |
830 |
315 |
$48K |
| D1120 |
Prophylaxis - child |
1,140 |
1,124 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
550 |
358 |
$46K |
| D4341 |
|
291 |
114 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,526 |
1,517 |
$43K |
| D9110 |
|
723 |
710 |
$39K |
| D5110 |
|
56 |
56 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,183 |
1,174 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
243 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
824 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
810 |
795 |
$21K |
| D1110 |
Prophylaxis - adult |
399 |
399 |
$19K |
| D2332 |
|
166 |
78 |
$18K |
| D5120 |
|
38 |
38 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,969 |
1,929 |
$12K |
| D0330 |
Panoramic radiographic image |
462 |
460 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,593 |
1,556 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
361 |
$7K |
| D2335 |
|
39 |
25 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
133 |
$2K |
| D0272 |
Bitewings - two radiographic images |
196 |
191 |
$2K |