| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
880 |
353 |
$119K |
| D1110 |
Prophylaxis - adult |
1,516 |
1,457 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,392 |
1,329 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
670 |
648 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,188 |
1,112 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,268 |
1,232 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
356 |
230 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,780 |
1,672 |
$25K |
| D1120 |
Prophylaxis - child |
490 |
473 |
$22K |
| D0274 |
Bitewings - four radiographic images |
674 |
644 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,249 |
933 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
68 |
$13K |
| D1206 |
Topical application of fluoride varnish |
425 |
411 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
65 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
27 |
$3K |
| D4342 |
|
36 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$2K |
| D0270 |
|
12 |
12 |
$147.00 |