| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,365 |
618 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,110 |
4,092 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,860 |
1,124 |
$138K |
| D9243 |
|
1,500 |
322 |
$118K |
| D4346 |
|
816 |
815 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,494 |
1,405 |
$78K |
| D1110 |
Prophylaxis - adult |
1,745 |
1,738 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,604 |
2,593 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,674 |
4,599 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,684 |
1,644 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,207 |
2,201 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,905 |
3,323 |
$38K |
| D9239 |
|
285 |
272 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
539 |
367 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
220 |
172 |
$19K |
| D1120 |
Prophylaxis - child |
413 |
413 |
$13K |
| D0270 |
|
303 |
299 |
$3K |
| D7220 |
|
20 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
129 |
128 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
109 |
108 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$763.31 |