| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,797 |
657 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
479 |
$18K |
| D1110 |
Prophylaxis - adult |
289 |
286 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
653 |
645 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
435 |
432 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
76 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
287 |
287 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
80 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
739 |
724 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
109 |
$4K |
| D0330 |
Panoramic radiographic image |
87 |
85 |
$2K |
| D0274 |
Bitewings - four radiographic images |
61 |
61 |
$1K |
| D4910 |
|
18 |
13 |
$325.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
28 |
$170.75 |