| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,073 |
464 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,199 |
728 |
$84K |
| D1110 |
Prophylaxis - adult |
1,078 |
1,068 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
777 |
680 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,267 |
1,236 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
179 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,558 |
1,532 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,288 |
1,258 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
233 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,181 |
2,098 |
$18K |
| D1120 |
Prophylaxis - child |
605 |
593 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,022 |
981 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,351 |
1,121 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
22 |
12 |
$11K |
| D9630 |
|
468 |
462 |
$6K |
| D0274 |
Bitewings - four radiographic images |
387 |
378 |
$5K |
| D0330 |
Panoramic radiographic image |
125 |
119 |
$4K |
| D2950 |
|
31 |
14 |
$3K |
| D4342 |
|
31 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
150 |
147 |
$2K |
| D0270 |
|
158 |
156 |
$435.90 |
| D1206 |
Topical application of fluoride varnish |
84 |
84 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
12 |
$0.00 |
| D4910 |
|
40 |
40 |
$0.00 |