| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,769 |
563 |
$217K |
| D0140 |
Limited oral evaluation - problem focused |
3,849 |
3,322 |
$176K |
| D1110 |
Prophylaxis - adult |
269 |
262 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
243 |
$15K |
| D1330 |
|
384 |
378 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
204 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,500 |
1,339 |
$11K |
| D1206 |
Topical application of fluoride varnish |
444 |
435 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
261 |
256 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,885 |
391 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
28 |
$7K |
| D0330 |
Panoramic radiographic image |
110 |
108 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$2K |
| D1310 |
|
222 |
216 |
$2K |
| D4346 |
|
13 |
12 |
$769.71 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$456.00 |
| D1320 |
|
39 |
39 |
$289.77 |