| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
906 |
229 |
$144K |
| D1110 |
Prophylaxis - adult |
1,853 |
1,767 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
783 |
209 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,482 |
1,381 |
$56K |
| D0330 |
Panoramic radiographic image |
1,115 |
1,039 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,020 |
1,890 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,073 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
838 |
642 |
$28K |
| D0274 |
Bitewings - four radiographic images |
883 |
836 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,516 |
1,427 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
187 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
877 |
739 |
$10K |
| D2949 |
|
45 |
39 |
$8K |
| D1120 |
Prophylaxis - child |
216 |
211 |
$7K |
| D5110 |
|
15 |
13 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
78 |
$1K |
| D1999 |
|
356 |
306 |
$819.47 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$460.46 |