| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
928 |
856 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
715 |
328 |
$46K |
| D1110 |
Prophylaxis - adult |
1,262 |
1,159 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,636 |
1,518 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
291 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
413 |
197 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
577 |
524 |
$13K |
| D2332 |
|
175 |
108 |
$11K |
| D1120 |
Prophylaxis - child |
245 |
235 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,275 |
1,153 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
96 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
159 |
112 |
$6K |
| D0274 |
Bitewings - four radiographic images |
253 |
240 |
$6K |
| D2394 |
|
65 |
48 |
$3K |
| D2335 |
|
41 |
28 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
566 |
218 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
119 |
$2K |
| D9110 |
|
13 |
13 |
$222.69 |
| D9986 |
|
27 |
23 |
$9.00 |