| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,647 |
644 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,690 |
655 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
1,584 |
1,427 |
$80K |
| D1110 |
Prophylaxis - adult |
765 |
747 |
$49K |
| D0330 |
Panoramic radiographic image |
505 |
433 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
153 |
$32K |
| D9310 |
|
367 |
338 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,060 |
975 |
$23K |
| D1206 |
Topical application of fluoride varnish |
801 |
780 |
$22K |
| D7250 |
|
128 |
52 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
105 |
$15K |
| D0274 |
Bitewings - four radiographic images |
325 |
318 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
300 |
290 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
33 |
12 |
$8K |
| D9243 |
|
62 |
25 |
$7K |
| D9239 |
|
42 |
37 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
45 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
27 |
$2K |