| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
392 |
226 |
$52K |
| D1110 |
Prophylaxis - adult |
555 |
539 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
524 |
504 |
$20K |
| D0274 |
Bitewings - four radiographic images |
498 |
484 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
938 |
872 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
324 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
549 |
536 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
64 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
468 |
417 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
146 |
144 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
62 |
$4K |
| D7311 |
|
32 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
46 |
45 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
14 |
$2K |
| D1330 |
|
13 |
12 |
$182.00 |