| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,522 |
674 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
1,238 |
1,101 |
$66K |
| D4342 |
|
1,303 |
404 |
$64K |
| D0330 |
Panoramic radiographic image |
1,644 |
1,319 |
$62K |
| D9630 |
|
3,911 |
3,286 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,218 |
1,882 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
367 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,004 |
1,586 |
$37K |
| D1110 |
Prophylaxis - adult |
741 |
709 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,759 |
1,229 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,666 |
1,633 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,820 |
2,274 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
939 |
915 |
$17K |
| D0274 |
Bitewings - four radiographic images |
639 |
629 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
85 |
$13K |
| D7250 |
|
141 |
50 |
$13K |
| D3320 |
|
27 |
24 |
$11K |
| D4910 |
|
228 |
223 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
41 |
$4K |
| D1120 |
Prophylaxis - child |
158 |
158 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
12 |
$3K |
| D2950 |
|
15 |
13 |
$2K |