| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,045 |
505 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,088 |
546 |
$144K |
| D2394 |
|
486 |
266 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
798 |
502 |
$137K |
| D2335 |
|
412 |
219 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
326 |
239 |
$84K |
| D0330 |
Panoramic radiographic image |
1,170 |
1,126 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,015 |
971 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
825 |
278 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,015 |
978 |
$27K |
| D1110 |
Prophylaxis - adult |
342 |
335 |
$19K |
| D2332 |
|
72 |
46 |
$15K |
| D7286 |
|
106 |
94 |
$11K |
| D2331 |
|
47 |
30 |
$7K |
| D2330 |
|
50 |
38 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
145 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$2K |
| D9410 |
|
28 |
26 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$612.40 |