| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,458 |
1,639 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,177 |
1,639 |
$170K |
| D1110 |
Prophylaxis - adult |
5,911 |
4,979 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,919 |
3,772 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
6,485 |
5,335 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,230 |
7,138 |
$136K |
| D1120 |
Prophylaxis - child |
3,433 |
3,040 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
6,069 |
5,383 |
$123K |
| D0274 |
Bitewings - four radiographic images |
4,464 |
3,809 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,563 |
2,100 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,385 |
775 |
$68K |
| D0330 |
Panoramic radiographic image |
2,597 |
1,761 |
$59K |
| D7250 |
|
1,007 |
255 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,209 |
427 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,810 |
4,027 |
$41K |
| D9310 |
|
2,308 |
1,637 |
$30K |
| D7230 |
|
407 |
121 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
342 |
203 |
$20K |
| D1351 |
Sealant - per tooth |
332 |
86 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
850 |
540 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
37 |
$3K |
| D0272 |
Bitewings - two radiographic images |
94 |
84 |
$2K |
| D2332 |
|
29 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
134 |
112 |
$2K |
| D2331 |
|
28 |
12 |
$1K |
| D2140 |
|
24 |
12 |
$1K |
| D2940 |
|
21 |
16 |
$546.00 |
| D0270 |
|
67 |
64 |
$467.46 |
| D1320 |
|
67 |
51 |
$174.98 |
| D0603 |
|
91 |
64 |
$0.00 |
| D1330 |
|
437 |
326 |
$0.00 |
| D1310 |
|
86 |
62 |
$0.00 |
| D0601 |
|
130 |
89 |
$0.00 |
| D0602 |
|
61 |
39 |
$0.00 |
| D0431 |
|
308 |
218 |
$0.00 |