| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,454 |
1,206 |
$515K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,172 |
1,021 |
$148K |
| D0274 |
Bitewings - four radiographic images |
3,845 |
3,572 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,996 |
2,789 |
$101K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,086 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,695 |
800 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,201 |
2,975 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,215 |
2,006 |
$64K |
| D1351 |
Sealant - per tooth |
2,674 |
421 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,368 |
3,649 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,896 |
1,771 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,787 |
2,706 |
$31K |
| D1120 |
Prophylaxis - child |
1,299 |
1,191 |
$29K |
| D0330 |
Panoramic radiographic image |
660 |
601 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
170 |
$14K |
| D4341 |
|
157 |
24 |
$13K |
| D0272 |
Bitewings - two radiographic images |
656 |
602 |
$12K |
| D2394 |
|
62 |
28 |
$7K |
| D7250 |
|
20 |
14 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
516 |
324 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D4346 |
|
29 |
27 |
$2K |
| D4910 |
|
14 |
12 |
$2K |
| D1354 |
|
134 |
33 |
$2K |
| D1999 |
|
778 |
706 |
$60.48 |
| D1330 |
|
471 |
429 |
$0.00 |