| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,464 |
416 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
580 |
$19K |
| D0274 |
Bitewings - four radiographic images |
733 |
664 |
$15K |
| D0330 |
Panoramic radiographic image |
407 |
360 |
$14K |
| D1206 |
Topical application of fluoride varnish |
232 |
219 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,961 |
486 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
243 |
82 |
$9K |
| D1120 |
Prophylaxis - child |
184 |
175 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
570 |
$9K |
| D1351 |
Sealant - per tooth |
377 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
174 |
$5K |
| D7311 |
|
154 |
62 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
131 |
123 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$1K |
| D5899 |
|
62 |
42 |
$594.50 |