| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,489 |
496 |
$31K |
| D9310 |
|
318 |
317 |
$14K |
| D2950 |
|
454 |
314 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
775 |
$3K |
| D1110 |
Prophylaxis - adult |
139 |
139 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
224 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
455 |
247 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
276 |
276 |
$288.20 |
| D0140 |
Limited oral evaluation - problem focused |
189 |
184 |
$64.56 |
| D0230 |
Intraoral - periapical each additional radiographic image |
202 |
152 |
$43.59 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
80 |
$0.00 |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
18 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$0.00 |
| D7250 |
|
104 |
50 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
86 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
24 |
24 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$0.00 |