| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
300 |
297 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
131 |
72 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
331 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
106 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
64 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
28 |
$3K |
| D1110 |
Prophylaxis - adult |
63 |
60 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
45 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$435.75 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
62 |
$357.12 |