| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,040 |
1,000 |
$375K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,905 |
1,120 |
$221K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,228 |
1,306 |
$210K |
| D1110 |
Prophylaxis - adult |
3,773 |
3,489 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,060 |
1,830 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
3,843 |
3,396 |
$122K |
| D2394 |
|
812 |
462 |
$110K |
| D7250 |
|
808 |
156 |
$83K |
| D2335 |
|
752 |
377 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,071 |
1,842 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,820 |
2,648 |
$66K |
| D0330 |
Panoramic radiographic image |
1,454 |
1,301 |
$65K |
| D2332 |
|
510 |
277 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,142 |
2,740 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,320 |
1,211 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
251 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
637 |
189 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,746 |
1,611 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,377 |
865 |
$27K |
| D4355 |
|
399 |
372 |
$25K |
| D5110 |
|
38 |
28 |
$16K |
| D5120 |
|
18 |
14 |
$8K |
| D0170 |
|
273 |
227 |
$7K |
| D1120 |
Prophylaxis - child |
176 |
163 |
$5K |
| D7310 |
|
43 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
88 |
85 |
$2K |