| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
410 |
93 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
97 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
43 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
296 |
$10K |
| D0330 |
Panoramic radiographic image |
259 |
241 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
95 |
$7K |
| D0274 |
Bitewings - four radiographic images |
296 |
275 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
453 |
$6K |
| D1110 |
Prophylaxis - adult |
121 |
114 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
209 |
198 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
425 |
399 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
62 |
$1K |