| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,043 |
1,010 |
$335K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,695 |
458 |
$149K |
| D0330 |
Panoramic radiographic image |
1,270 |
1,177 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,366 |
1,251 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,042 |
965 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
466 |
249 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
839 |
755 |
$34K |
| D1110 |
Prophylaxis - adult |
553 |
510 |
$28K |
| D7250 |
|
138 |
56 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
236 |
141 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
55 |
$7K |
| D0274 |
Bitewings - four radiographic images |
107 |
100 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
154 |
141 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
86 |
$893.08 |