| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,593 |
711 |
$136K |
| D1351 |
Sealant - per tooth |
1,970 |
623 |
$99K |
| D1120 |
Prophylaxis - child |
1,795 |
1,793 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,250 |
2,218 |
$62K |
| D1110 |
Prophylaxis - adult |
1,238 |
1,222 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,505 |
1,503 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,593 |
1,579 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,366 |
3,859 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,772 |
1,757 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,656 |
4,348 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
390 |
380 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
390 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
82 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
52 |
$5K |
| D2394 |
|
28 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
39 |
$2K |
| D9110 |
|
16 |
15 |
$880.00 |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$771.62 |
| D0270 |
|
41 |
39 |
$229.60 |