| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,570 |
722 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,492 |
2,477 |
$163K |
| D1110 |
Prophylaxis - adult |
1,318 |
1,304 |
$116K |
| D9430 |
|
1,815 |
1,586 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,167 |
1,158 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,150 |
1,137 |
$17K |
| D0330 |
Panoramic radiographic image |
321 |
320 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
99 |
90 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
27 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
41 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
480 |
$5K |
| D1206 |
Topical application of fluoride varnish |
223 |
223 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
170 |
$2K |