| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2721 |
|
130 |
74 |
$139K |
| D0330 |
Panoramic radiographic image |
1,572 |
1,550 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
756 |
285 |
$110K |
| D1110 |
Prophylaxis - adult |
1,428 |
1,391 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,907 |
1,879 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,654 |
1,632 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,484 |
1,467 |
$62K |
| D2722 |
|
62 |
36 |
$57K |
| D2950 |
|
186 |
112 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,909 |
1,865 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
55 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
438 |
428 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
88 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,273 |
976 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
84 |
$13K |
| D1206 |
Topical application of fluoride varnish |
304 |
304 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
46 |
28 |
$5K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D1330 |
|
162 |
154 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$957.46 |
| D0270 |
|
24 |
24 |
$358.34 |