| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,869 |
1,318 |
$275K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,495 |
982 |
$198K |
| D0140 |
Limited oral evaluation - problem focused |
5,285 |
5,064 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,000 |
1,958 |
$98K |
| D5110 |
|
107 |
98 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,406 |
2,352 |
$53K |
| D9613 |
|
241 |
225 |
$46K |
| D1110 |
Prophylaxis - adult |
1,432 |
1,394 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,457 |
1,436 |
$42K |
| D0330 |
Panoramic radiographic image |
659 |
629 |
$36K |
| D1120 |
Prophylaxis - child |
603 |
600 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,452 |
2,356 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
203 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
643 |
639 |
$17K |
| D5120 |
|
27 |
24 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
957 |
566 |
$8K |
| D7450 |
|
131 |
125 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
86 |
$7K |
| D7230 |
|
30 |
15 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
111 |
$4K |
| D9110 |
|
58 |
49 |
$2K |
| D1320 |
|
75 |
56 |
$223.08 |