| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,896 |
806 |
$165K |
| D1110 |
Prophylaxis - adult |
5,563 |
5,069 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
3,407 |
2,909 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,317 |
2,825 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
4,243 |
3,753 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,000 |
555 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,944 |
2,574 |
$48K |
| D2394 |
|
492 |
214 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,379 |
3,046 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,312 |
2,013 |
$41K |
| D4355 |
|
408 |
388 |
$33K |
| D1351 |
Sealant - per tooth |
1,194 |
128 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
699 |
409 |
$22K |
| D2335 |
|
264 |
70 |
$22K |
| D1120 |
Prophylaxis - child |
1,288 |
1,058 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
201 |
116 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,255 |
1,116 |
$15K |
| D0330 |
Panoramic radiographic image |
564 |
452 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
409 |
205 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,543 |
1,230 |
$10K |
| D0160 |
|
125 |
123 |
$5K |
| D9110 |
|
183 |
172 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
59 |
$4K |
| D0170 |
|
138 |
127 |
$2K |
| D2140 |
|
69 |
40 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D2160 |
|
18 |
12 |
$959.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
229 |
118 |
$935.72 |
| D7510 |
|
17 |
14 |
$885.22 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$224.96 |
| D1330 |
|
26 |
18 |
$0.00 |