| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,244 |
1,110 |
$386K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,605 |
1,738 |
$296K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,763 |
1,343 |
$267K |
| D0210 |
Intraoral - complete series of radiographic images |
2,685 |
1,980 |
$135K |
| D1110 |
Prophylaxis - adult |
4,655 |
3,507 |
$131K |
| D2394 |
|
1,142 |
630 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,727 |
915 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
3,595 |
2,609 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,429 |
3,277 |
$80K |
| D2335 |
|
765 |
332 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,965 |
1,453 |
$61K |
| D2332 |
|
732 |
323 |
$49K |
| D0330 |
Panoramic radiographic image |
1,159 |
879 |
$48K |
| D4355 |
|
856 |
618 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,574 |
1,198 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,888 |
2,072 |
$34K |
| D2331 |
|
599 |
297 |
$33K |
| D1120 |
Prophylaxis - child |
1,632 |
1,156 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,041 |
1,511 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,336 |
678 |
$21K |
| D2330 |
|
289 |
138 |
$12K |
| D0272 |
Bitewings - two radiographic images |
808 |
536 |
$10K |
| D3310 |
|
30 |
29 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
39 |
$7K |
| D4341 |
|
35 |
13 |
$3K |