| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
116 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
116 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
223 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
69 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
53 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
91 |
$4K |
| D0272 |
Bitewings - two radiographic images |
184 |
175 |
$3K |
| D2394 |
|
22 |
19 |
$2K |
| D0330 |
Panoramic radiographic image |
58 |
51 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
24 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
20 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
35 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
129 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
53 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
29 |
$918.25 |