| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
638 |
360 |
$40K |
| D4341 |
|
251 |
123 |
$37K |
| D1120 |
Prophylaxis - child |
636 |
575 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
990 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
769 |
710 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,077 |
942 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
490 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
112 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
504 |
457 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
71 |
$8K |
| D0330 |
Panoramic radiographic image |
478 |
405 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,232 |
1,087 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
305 |
$5K |
| D1110 |
Prophylaxis - adult |
139 |
124 |
$5K |
| D1351 |
Sealant - per tooth |
98 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
869 |
716 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
29 |
$2K |
| D0272 |
Bitewings - two radiographic images |
280 |
254 |
$2K |
| D9110 |
|
12 |
12 |
$612.95 |