| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,346 |
506 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,511 |
3,074 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,295 |
318 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,353 |
779 |
$108K |
| D1110 |
Prophylaxis - adult |
2,103 |
1,858 |
$105K |
| D1351 |
Sealant - per tooth |
2,504 |
325 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,207 |
2,749 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,112 |
1,810 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
816 |
489 |
$49K |
| D1120 |
Prophylaxis - child |
1,315 |
1,189 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,591 |
3,122 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,088 |
976 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
282 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,713 |
1,552 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
2,249 |
1,409 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
992 |
898 |
$25K |
| D0330 |
Panoramic radiographic image |
236 |
208 |
$12K |
| D0272 |
Bitewings - two radiographic images |
453 |
412 |
$10K |
| D0270 |
|
283 |
256 |
$4K |
| D2335 |
|
18 |
12 |
$3K |
| D2332 |
|
23 |
13 |
$2K |
| D2331 |
|
20 |
13 |
$1K |
| D2330 |
|
25 |
13 |
$1K |
| D1330 |
|
563 |
522 |
$0.00 |