| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
667 |
358 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
1,274 |
1,087 |
$74K |
| D2949 |
|
392 |
294 |
$72K |
| D7250 |
|
308 |
139 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,121 |
1,060 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
412 |
247 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
834 |
$33K |
| D0330 |
Panoramic radiographic image |
444 |
428 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
122 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
634 |
567 |
$8K |
| D2335 |
|
39 |
24 |
$7K |
| D0274 |
Bitewings - four radiographic images |
114 |
101 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
379 |
302 |
$4K |
| D1110 |
Prophylaxis - adult |
66 |
63 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
117 |
$3K |
| D2332 |
|
21 |
16 |
$2K |
| D2331 |
|
19 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
26 |
25 |
$438.57 |