| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
826 |
468 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
782 |
300 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
791 |
284 |
$74K |
| D1110 |
Prophylaxis - adult |
975 |
972 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,222 |
1,191 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,086 |
1,102 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,319 |
1,317 |
$30K |
| D0274 |
Bitewings - four radiographic images |
903 |
903 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,941 |
1,903 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
515 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
74 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
440 |
440 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
17 |
$12K |
| D0330 |
Panoramic radiographic image |
207 |
207 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$4K |
| D2330 |
|
27 |
16 |
$2K |