| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,323 |
646 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,655 |
803 |
$133K |
| D0274 |
Bitewings - four radiographic images |
2,714 |
2,537 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,507 |
2,361 |
$95K |
| D1110 |
Prophylaxis - adult |
1,892 |
1,795 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,701 |
2,731 |
$55K |
| D1351 |
Sealant - per tooth |
1,930 |
292 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
450 |
259 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,356 |
3,054 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,737 |
1,633 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
531 |
278 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,314 |
1,260 |
$29K |
| D4346 |
|
115 |
105 |
$22K |
| D1120 |
Prophylaxis - child |
630 |
600 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
535 |
$21K |
| D7250 |
|
76 |
26 |
$16K |
| D0330 |
Panoramic radiographic image |
266 |
253 |
$16K |
| D2335 |
|
61 |
30 |
$10K |
| D2394 |
|
57 |
40 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
25 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
406 |
$6K |
| D0272 |
Bitewings - two radiographic images |
47 |
44 |
$1K |