| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,044 |
232 |
$136K |
| D0330 |
Panoramic radiographic image |
1,798 |
1,664 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,730 |
2,478 |
$86K |
| D1110 |
Prophylaxis - adult |
1,381 |
1,283 |
$62K |
| D1351 |
Sealant - per tooth |
1,193 |
150 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,143 |
1,022 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
360 |
87 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,145 |
1,016 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
479 |
453 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
24 |
$11K |
| D1120 |
Prophylaxis - child |
275 |
254 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
179 |
162 |
$2K |
| D0274 |
Bitewings - four radiographic images |
97 |
87 |
$2K |
| D2161 |
|
16 |
12 |
$1K |