| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,112 |
5,015 |
$1.60M |
| D0140 |
Limited oral evaluation - problem focused |
12,696 |
11,664 |
$432K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,164 |
1,504 |
$270K |
| D0330 |
Panoramic radiographic image |
4,145 |
3,788 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,728 |
1,068 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,143 |
798 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
7,507 |
6,784 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,947 |
1,589 |
$71K |
| D0270 |
|
3,732 |
3,482 |
$69K |
| D2394 |
|
559 |
416 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,131 |
991 |
$41K |
| D1110 |
Prophylaxis - adult |
671 |
649 |
$35K |
| D3320 |
|
61 |
51 |
$27K |
| D2335 |
|
118 |
80 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,789 |
1,371 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
177 |
$16K |
| D0274 |
Bitewings - four radiographic images |
192 |
185 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
217 |
209 |
$5K |
| D0272 |
Bitewings - two radiographic images |
183 |
170 |
$5K |
| D2332 |
|
18 |
13 |
$2K |
| D9248 |
|
24 |
24 |
$589.05 |