| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,075 |
429 |
$119K |
| D5110 |
|
245 |
245 |
$97K |
| D5212 |
|
215 |
213 |
$75K |
| D5120 |
|
134 |
134 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,442 |
382 |
$68K |
| D5211 |
|
177 |
175 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,138 |
2,101 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,374 |
1,264 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
547 |
355 |
$28K |
| D1110 |
Prophylaxis - adult |
1,108 |
1,094 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
385 |
225 |
$23K |
| D0330 |
Panoramic radiographic image |
647 |
635 |
$20K |
| D2335 |
|
318 |
162 |
$19K |
| D2332 |
|
323 |
204 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,123 |
1,105 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
146 |
$7K |
| D1120 |
Prophylaxis - child |
160 |
160 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
206 |
206 |
$4K |
| D2950 |
|
55 |
44 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
207 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
448 |
425 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
338 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
182 |
182 |
$3K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |
| D7250 |
|
239 |
85 |
$0.00 |