| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
449 |
207 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,345 |
1,245 |
$47K |
| D1110 |
Prophylaxis - adult |
1,032 |
972 |
$46K |
| D0274 |
Bitewings - four radiographic images |
808 |
775 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
535 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,358 |
1,280 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
120 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
569 |
541 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
580 |
482 |
$6K |
| D0330 |
Panoramic radiographic image |
122 |
118 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
68 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
26 |
$3K |
| D9110 |
|
58 |
56 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$203.00 |
| D1999 |
|
1,269 |
989 |
$0.00 |