| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,011 |
1,097 |
$248K |
| D0210 |
Intraoral - complete series of radiographic images |
3,322 |
3,144 |
$143K |
| D2394 |
|
1,548 |
791 |
$126K |
| D1110 |
Prophylaxis - adult |
4,255 |
4,038 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,223 |
1,166 |
$126K |
| D8670 |
Periodic orthodontic treatment visit |
1,161 |
1,032 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,379 |
838 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,654 |
3,509 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
3,350 |
3,186 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,342 |
2,202 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,465 |
2,340 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
2,222 |
2,091 |
$41K |
| D2335 |
|
479 |
179 |
$35K |
| D1120 |
Prophylaxis - child |
1,136 |
1,085 |
$30K |
| D1351 |
Sealant - per tooth |
632 |
73 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,739 |
1,589 |
$12K |
| D0330 |
Panoramic radiographic image |
204 |
187 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
84 |
$6K |
| D9110 |
|
225 |
212 |
$5K |
| D0272 |
Bitewings - two radiographic images |
195 |
181 |
$3K |
| D2954 |
|
29 |
27 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
29 |
$3K |
| D4355 |
|
27 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
96 |
92 |
$1K |
| D7510 |
|
20 |
17 |
$688.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
88 |
$459.98 |