| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,968 |
1,369 |
$325K |
| D1351 |
Sealant - per tooth |
13,082 |
1,460 |
$323K |
| D1110 |
Prophylaxis - adult |
4,460 |
4,302 |
$179K |
| D0274 |
Bitewings - four radiographic images |
5,089 |
4,906 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,790 |
953 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
4,768 |
4,416 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,032 |
3,909 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
5,165 |
4,967 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,097 |
510 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,372 |
1,328 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,842 |
5,461 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,897 |
2,807 |
$50K |
| D1120 |
Prophylaxis - child |
1,764 |
1,699 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
276 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,261 |
1,290 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
68 |
$13K |
| D2394 |
|
113 |
72 |
$11K |
| D0330 |
Panoramic radiographic image |
410 |
400 |
$10K |
| D2335 |
|
85 |
37 |
$9K |
| D1206 |
Topical application of fluoride varnish |
300 |
294 |
$5K |
| D0270 |
|
282 |
273 |
$4K |
| D0240 |
|
194 |
93 |
$3K |
| D1999 |
|
362 |
261 |
$10.00 |