| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,020 |
444 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
684 |
648 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
311 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
452 |
261 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
689 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
259 |
160 |
$17K |
| D2394 |
|
127 |
76 |
$8K |
| D1110 |
Prophylaxis - adult |
127 |
126 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
238 |
227 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
115 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
41 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
354 |
$2K |
| D2335 |
|
27 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
94 |
86 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$380.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
40 |
$310.95 |