| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,145 |
435 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
1,088 |
953 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,260 |
1,118 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
38 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
210 |
197 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
55 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
262 |
$4K |
| D1110 |
Prophylaxis - adult |
70 |
67 |
$4K |
| D0274 |
Bitewings - four radiographic images |
45 |
40 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
149 |
108 |
$1K |
| D0330 |
Panoramic radiographic image |
22 |
19 |
$1K |