| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,563 |
951 |
$84K |
| D0330 |
Panoramic radiographic image |
2,230 |
1,822 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,165 |
2,585 |
$58K |
| D1110 |
Prophylaxis - adult |
1,256 |
1,048 |
$37K |
| D2335 |
|
577 |
250 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
625 |
510 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,489 |
1,166 |
$12K |
| D1120 |
Prophylaxis - child |
345 |
272 |
$11K |
| D2332 |
|
58 |
36 |
$3K |
| D0274 |
Bitewings - four radiographic images |
143 |
142 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
43 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
185 |
169 |
$3K |
| D2394 |
|
44 |
31 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
310 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
229 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
278 |
87 |
$0.00 |