| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
396 |
180 |
$56K |
| D7311 |
|
385 |
211 |
$48K |
| D0330 |
Panoramic radiographic image |
485 |
479 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
568 |
559 |
$22K |
| D3310 |
|
41 |
13 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
28 |
13 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
331 |
$16K |
| D1110 |
Prophylaxis - adult |
270 |
268 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
73 |
$14K |
| D7230 |
|
52 |
33 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$11K |
| D2954 |
|
44 |
14 |
$9K |
| D7220 |
|
45 |
30 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
185 |
184 |
$5K |
| D4341 |
|
32 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
71 |
70 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
37 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$453.00 |