| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,014 |
518 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
1,350 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,253 |
750 |
$84K |
| D9430 |
|
2,187 |
2,033 |
$65K |
| D1120 |
Prophylaxis - child |
1,814 |
1,805 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
764 |
762 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
711 |
431 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
820 |
815 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,742 |
2,598 |
$32K |
| D0350 |
|
2,889 |
794 |
$26K |
| D1206 |
Topical application of fluoride varnish |
2,058 |
2,052 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,410 |
2,333 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
232 |
125 |
$13K |
| D1110 |
Prophylaxis - adult |
141 |
140 |
$12K |
| D0274 |
Bitewings - four radiographic images |
547 |
546 |
$8K |
| D1351 |
Sealant - per tooth |
184 |
44 |
$6K |
| D9993 |
|
80 |
80 |
$5K |
| D1310 |
|
104 |
104 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$3K |
| D4341 |
|
34 |
12 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31 |
29 |
$372.00 |