| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
328 |
83 |
$19K |
| D2950 |
|
155 |
117 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
573 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
254 |
219 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
198 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
14 |
$5K |
| D0330 |
Panoramic radiographic image |
116 |
116 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
74 |
$4K |
| D1110 |
Prophylaxis - adult |
155 |
155 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
284 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
12 |
$581.20 |
| D2740 |
Crown - porcelain/ceramic |
18 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
15 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
71 |
71 |
$0.00 |
| D9630 |
|
24 |
24 |
$0.00 |