| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,328 |
1,510 |
$493K |
| D4341 |
|
8,727 |
2,153 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,012 |
987 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,388 |
826 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,308 |
3,094 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,585 |
4,366 |
$66K |
| D1110 |
Prophylaxis - adult |
1,187 |
1,130 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,791 |
1,752 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,270 |
4,953 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,687 |
1,572 |
$37K |
| D0274 |
Bitewings - four radiographic images |
3,112 |
2,942 |
$32K |
| D0330 |
Panoramic radiographic image |
952 |
883 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,553 |
4,303 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
345 |
187 |
$15K |
| D4910 |
|
159 |
157 |
$11K |
| D2332 |
|
195 |
94 |
$11K |
| D1999 |
|
837 |
708 |
$10K |
| D1120 |
Prophylaxis - child |
234 |
229 |
$5K |
| D0272 |
Bitewings - two radiographic images |
386 |
374 |
$4K |
| D1351 |
Sealant - per tooth |
134 |
27 |
$2K |
| D9110 |
|
20 |
13 |
$544.46 |