| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
644 |
268 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
550 |
150 |
$45K |
| D0330 |
Panoramic radiographic image |
600 |
581 |
$34K |
| D1110 |
Prophylaxis - adult |
590 |
577 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,529 |
1,191 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,459 |
2,081 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
735 |
697 |
$20K |
| D0274 |
Bitewings - four radiographic images |
605 |
595 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
330 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
531 |
527 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
42 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
370 |
363 |
$9K |
| D9630 |
|
97 |
96 |
$2K |
| D1120 |
Prophylaxis - child |
60 |
60 |
$2K |
| D4355 |
|
13 |
13 |
$1K |