| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,767 |
1,186 |
$235K |
| D0330 |
Panoramic radiographic image |
4,022 |
4,021 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,666 |
3,666 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,368 |
781 |
$124K |
| D1110 |
Prophylaxis - adult |
2,208 |
2,207 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,828 |
3,827 |
$97K |
| D7230 |
|
303 |
188 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,804 |
5,771 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,431 |
1,426 |
$54K |
| D7250 |
|
365 |
211 |
$53K |
| D1120 |
Prophylaxis - child |
1,361 |
1,361 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
498 |
218 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,536 |
4,526 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,780 |
1,779 |
$41K |
| D7240 |
Removal of impacted tooth - completely bony |
123 |
62 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
325 |
201 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,709 |
1,709 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
88 |
$10K |
| D0272 |
Bitewings - two radiographic images |
529 |
529 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
320 |
320 |
$5K |
| D0240 |
|
211 |
106 |
$3K |
| D2331 |
|
31 |
18 |
$2K |
| D2394 |
|
17 |
12 |
$2K |