| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,502 |
380 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,119 |
646 |
$153K |
| D4341 |
|
2,166 |
512 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,225 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,292 |
1,103 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
425 |
223 |
$43K |
| D1110 |
Prophylaxis - adult |
601 |
497 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,018 |
897 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
149 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
304 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
83 |
82 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
166 |
143 |
$2K |
| D2331 |
|
15 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$504.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
247 |
159 |
$489.63 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$367.68 |