| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,937 |
655 |
$448K |
| D0210 |
Intraoral - complete series of radiographic images |
1,284 |
1,275 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,561 |
1,546 |
$62K |
| D5130 |
|
41 |
41 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
117 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
54 |
$20K |
| D1110 |
Prophylaxis - adult |
322 |
320 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
146 |
$7K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$5K |
| D1206 |
Topical application of fluoride varnish |
338 |
334 |
$3K |
| D4346 |
|
46 |
46 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
49 |
49 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
38 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$382.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$379.59 |
| D9630 |
|
332 |
223 |
$0.00 |
| D4921 |
|
308 |
98 |
$0.00 |