| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
467 |
145 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
820 |
818 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
222 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
597 |
595 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
154 |
$18K |
| D1110 |
Prophylaxis - adult |
265 |
264 |
$17K |
| D4341 |
|
235 |
65 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,393 |
610 |
$12K |
| D1120 |
Prophylaxis - child |
339 |
338 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
334 |
333 |
$10K |
| D9430 |
|
221 |
209 |
$7K |
| D0350 |
|
776 |
330 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
530 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
542 |
541 |
$5K |
| D2931 |
|
19 |
16 |
$2K |
| D0274 |
Bitewings - four radiographic images |
132 |
132 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
69 |
19 |
$1K |