| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,252 |
344 |
$257K |
| D5110 |
|
241 |
239 |
$153K |
| D5120 |
|
202 |
201 |
$120K |
| D0330 |
Panoramic radiographic image |
1,840 |
1,790 |
$117K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,097 |
701 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,618 |
2,524 |
$88K |
| D1110 |
Prophylaxis - adult |
1,499 |
1,452 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
729 |
488 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,703 |
1,646 |
$43K |
| D1120 |
Prophylaxis - child |
417 |
409 |
$23K |
| D2332 |
|
227 |
132 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
350 |
338 |
$19K |
| D1206 |
Topical application of fluoride varnish |
789 |
771 |
$15K |
| D1351 |
Sealant - per tooth |
590 |
130 |
$14K |
| D1321 |
|
1,071 |
1,025 |
$13K |
| D2394 |
|
101 |
81 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
487 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,152 |
1,000 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
207 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
879 |
767 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
45 |
$4K |
| D2335 |
|
35 |
24 |
$4K |
| D3120 |
|
125 |
59 |
$585.12 |