| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
385 |
227 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,186 |
1,113 |
$45K |
| D1110 |
Prophylaxis - adult |
805 |
773 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,052 |
990 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
529 |
506 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
936 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
177 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
122 |
117 |
$4K |
| D1120 |
Prophylaxis - child |
69 |
65 |
$3K |
| D0274 |
Bitewings - four radiographic images |
86 |
82 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
24 |
$2K |