| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,399 |
515 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
769 |
495 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,509 |
1,486 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,198 |
1,669 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,282 |
1,271 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
519 |
306 |
$26K |
| D1110 |
Prophylaxis - adult |
753 |
743 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,969 |
1,908 |
$17K |
| D0330 |
Panoramic radiographic image |
214 |
211 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
639 |
$12K |
| D2332 |
|
69 |
51 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
932 |
802 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
79 |
$6K |
| D4341 |
|
252 |
118 |
$4K |
| D2335 |
|
20 |
12 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
318 |
313 |
$3K |
| D2330 |
|
47 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$351.39 |
| D7250 |
|
151 |
57 |
$0.00 |
| D2950 |
|
41 |
40 |
$0.00 |
| D4910 |
|
13 |
13 |
$0.00 |