| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,908 |
988 |
$147K |
| D0330 |
Panoramic radiographic image |
2,563 |
2,429 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
2,757 |
2,595 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,140 |
2,061 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,048 |
1,895 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
631 |
$21K |
| D1110 |
Prophylaxis - adult |
711 |
688 |
$14K |
| D4355 |
|
441 |
404 |
$11K |
| D0272 |
Bitewings - two radiographic images |
442 |
418 |
$7K |
| D1120 |
Prophylaxis - child |
116 |
112 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
40 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
149 |
141 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
15 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
91 |
87 |
$870.40 |
| D0160 |
|
30 |
30 |
$780.64 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$455.00 |