| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,597 |
1,323 |
$311K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,621 |
503 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
2,908 |
2,828 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
2,646 |
2,553 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,876 |
957 |
$21K |
| D0330 |
Panoramic radiographic image |
325 |
316 |
$19K |
| D0270 |
|
895 |
863 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
19 |
15 |
$8K |
| D1110 |
Prophylaxis - adult |
136 |
131 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
99 |
$4K |
| D0272 |
Bitewings - two radiographic images |
129 |
127 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D2950 |
|
13 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
54 |
52 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$874.96 |