| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,149 |
858 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
3,401 |
3,324 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,966 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,199 |
2,178 |
$63K |
| D1110 |
Prophylaxis - adult |
1,374 |
1,359 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,137 |
4,922 |
$57K |
| D0330 |
Panoramic radiographic image |
1,349 |
1,336 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,974 |
1,956 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,103 |
2,729 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
211 |
135 |
$15K |
| D0270 |
|
916 |
901 |
$9K |
| D1120 |
Prophylaxis - child |
118 |
116 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
38 |
$682.25 |
| D0120 |
Periodic oral evaluation - established patient |
40 |
36 |
$580.39 |