| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,363 |
1,362 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
717 |
299 |
$50K |
| D9310 |
|
412 |
412 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
451 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
587 |
587 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
583 |
583 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,067 |
1,042 |
$11K |
| D0330 |
Panoramic radiographic image |
306 |
306 |
$8K |
| D0274 |
Bitewings - four radiographic images |
299 |
299 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
507 |
503 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
229 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
13 |
$2K |