| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
806 |
270 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
624 |
$13K |
| D1120 |
Prophylaxis - child |
239 |
228 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
442 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
46 |
$6K |
| D1206 |
Topical application of fluoride varnish |
241 |
227 |
$6K |
| D0330 |
Panoramic radiographic image |
255 |
247 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
801 |
746 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
119 |
105 |
$3K |
| D0274 |
Bitewings - four radiographic images |
186 |
177 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
465 |
435 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$111.10 |