| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,105 |
395 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
797 |
773 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
402 |
248 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
135 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
544 |
522 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
671 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
147 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
900 |
870 |
$6K |
| D1110 |
Prophylaxis - adult |
188 |
182 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
376 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
51 |
$4K |
| D9110 |
|
74 |
72 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
117 |
112 |
$2K |
| D0274 |
Bitewings - four radiographic images |
199 |
190 |
$2K |
| D2335 |
|
22 |
14 |
$2K |
| D1120 |
Prophylaxis - child |
62 |
57 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
620 |
412 |
$1K |
| D2332 |
|
18 |
13 |
$928.05 |