| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,390 |
545 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
4,218 |
3,184 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,618 |
1,171 |
$60K |
| D1110 |
Prophylaxis - adult |
1,693 |
1,456 |
$58K |
| D7880 |
|
147 |
147 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,026 |
1,476 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
357 |
$37K |
| D9920 |
|
418 |
390 |
$24K |
| D0330 |
Panoramic radiographic image |
513 |
399 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,320 |
1,204 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
139 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
147 |
$17K |
| D0274 |
Bitewings - four radiographic images |
880 |
819 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,320 |
$15K |
| D1354 |
|
1,126 |
559 |
$12K |
| D9994 |
|
1,275 |
1,238 |
$8K |
| D4355 |
|
131 |
127 |
$6K |
| D9630 |
|
707 |
675 |
$6K |
| D9110 |
|
61 |
59 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
313 |
114 |
$2K |
| D1206 |
Topical application of fluoride varnish |
113 |
113 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$402.24 |
| D9995 |
|
317 |
279 |
$0.00 |
| D9610 |
|
66 |
64 |
$0.00 |
| D9219 |
|
44 |
42 |
$0.00 |