| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,040 |
466 |
$140K |
| D1110 |
Prophylaxis - adult |
2,153 |
2,103 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
790 |
483 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,537 |
2,484 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,642 |
2,477 |
$39K |
| D1120 |
Prophylaxis - child |
795 |
783 |
$38K |
| D0274 |
Bitewings - four radiographic images |
982 |
964 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
583 |
354 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,051 |
1,037 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
364 |
234 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
759 |
728 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
389 |
380 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,017 |
1,674 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
477 |
$20K |
| D0330 |
Panoramic radiographic image |
257 |
249 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
24 |
$4K |
| D2335 |
|
31 |
13 |
$3K |
| D2332 |
|
21 |
14 |
$2K |
| D2394 |
|
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
72 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$2K |
| D7311 |
|
22 |
13 |
$2K |
| D2330 |
|
20 |
13 |
$1K |
| D1999 |
|
36 |
27 |
$0.00 |