| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,277 |
1,290 |
$539K |
| D0330 |
Panoramic radiographic image |
2,790 |
2,744 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,086 |
786 |
$127K |
| D5110 |
|
186 |
185 |
$121K |
| D1110 |
Prophylaxis - adult |
2,189 |
2,129 |
$104K |
| D2394 |
|
1,336 |
640 |
$91K |
| D5120 |
|
133 |
133 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,691 |
2,628 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,020 |
599 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,801 |
1,756 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,323 |
2,269 |
$60K |
| D7310 |
|
262 |
119 |
$47K |
| D7510 |
|
314 |
287 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
187 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
791 |
784 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,282 |
1,235 |
$11K |
| D4341 |
|
144 |
53 |
$10K |
| D5130 |
|
14 |
14 |
$8K |
| D2332 |
|
124 |
76 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
245 |
243 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
86 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
571 |
223 |
$4K |
| D2335 |
|
35 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
38 |
$2K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$2K |
| D0270 |
|
24 |
24 |
$192.59 |
| D9986 |
|
36 |
34 |
$18.00 |