| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
953 |
237 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
496 |
280 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
566 |
76 |
$41K |
| D0330 |
Panoramic radiographic image |
606 |
551 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
596 |
$22K |
| D0274 |
Bitewings - four radiographic images |
496 |
442 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
798 |
718 |
$13K |
| D5140 |
|
13 |
13 |
$12K |
| D5130 |
|
13 |
13 |
$12K |
| D1110 |
Prophylaxis - adult |
214 |
195 |
$10K |
| D1206 |
Topical application of fluoride varnish |
399 |
357 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
767 |
675 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
66 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
134 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
16 |
$3K |
| D5410 |
|
36 |
29 |
$1K |
| D1120 |
Prophylaxis - child |
36 |
36 |
$1K |
| D5411 |
|
21 |
15 |
$837.88 |
| D1320 |
|
17 |
17 |
$624.42 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
12 |
$340.33 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$264.72 |