| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,130 |
614 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,485 |
2,223 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
514 |
332 |
$37K |
| D1110 |
Prophylaxis - adult |
796 |
791 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
448 |
425 |
$30K |
| D2394 |
|
314 |
261 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
222 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
652 |
$22K |
| D2950 |
|
115 |
89 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,320 |
2,089 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
121 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,863 |
868 |
$13K |
| D0274 |
Bitewings - four radiographic images |
439 |
437 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
380 |
378 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
13 |
$3K |
| D2332 |
|
20 |
14 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
114 |
$3K |
| D2161 |
|
24 |
19 |
$2K |
| D1320 |
|
55 |
55 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$535.08 |