| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,061 |
363 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,033 |
619 |
$134K |
| D1110 |
Prophylaxis - adult |
1,782 |
1,781 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
476 |
311 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,693 |
1,693 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
481 |
198 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
803 |
803 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
704 |
698 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
308 |
$24K |
| D2394 |
|
124 |
76 |
$24K |
| D0272 |
Bitewings - two radiographic images |
769 |
768 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
729 |
$13K |
| D1120 |
Prophylaxis - child |
260 |
260 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
386 |
385 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
38 |
$6K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$3K |