| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
697 |
147 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,944 |
2,583 |
$94K |
| D0330 |
Panoramic radiographic image |
1,680 |
1,446 |
$80K |
| D2335 |
|
695 |
256 |
$76K |
| D1110 |
Prophylaxis - adult |
1,646 |
1,433 |
$67K |
| D2394 |
|
322 |
213 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,220 |
1,043 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
915 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
574 |
504 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,040 |
927 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
104 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
61 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
468 |
389 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
63 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$949.05 |
| D0160 |
|
15 |
12 |
$780.00 |