| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,940 |
932 |
$532K |
| D0210 |
Intraoral - complete series of radiographic images |
915 |
761 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
833 |
$38K |
| D0330 |
Panoramic radiographic image |
578 |
554 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
764 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
40 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
86 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
443 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
132 |
$2K |
| D0274 |
Bitewings - four radiographic images |
53 |
51 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
108 |
100 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$735.39 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$323.40 |