| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,689 |
2,479 |
$286K |
| D4341 |
|
1,763 |
1,003 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
4,671 |
4,435 |
$125K |
| D1120 |
Prophylaxis - child |
2,998 |
2,842 |
$119K |
| D1351 |
Sealant - per tooth |
1,553 |
677 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,444 |
1,001 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,345 |
3,111 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,664 |
2,516 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
219 |
177 |
$61K |
| D1110 |
Prophylaxis - adult |
1,294 |
1,240 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
910 |
417 |
$54K |
| D0330 |
Panoramic radiographic image |
2,563 |
2,416 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,823 |
1,673 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,183 |
2,075 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,965 |
2,732 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,258 |
1,207 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
212 |
$20K |
| D2950 |
|
255 |
222 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,464 |
2,258 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
137 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
26 |
$8K |
| D5110 |
|
13 |
13 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
531 |
424 |
$2K |