| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,541 |
1,605 |
$156K |
| D0330 |
Panoramic radiographic image |
2,557 |
2,283 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,294 |
2,934 |
$70K |
| D4341 |
|
999 |
428 |
$60K |
| D1110 |
Prophylaxis - adult |
1,585 |
1,418 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,156 |
1,904 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,169 |
498 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
700 |
540 |
$33K |
| D1120 |
Prophylaxis - child |
769 |
695 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
461 |
380 |
$24K |
| D2331 |
|
431 |
318 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
559 |
400 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,412 |
1,271 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
407 |
$9K |
| D0272 |
Bitewings - two radiographic images |
374 |
344 |
$6K |
| D7250 |
|
49 |
25 |
$3K |
| D2332 |
|
32 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
343 |
252 |
$939.34 |