| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,118 |
945 |
$191K |
| D0140 |
Limited oral evaluation - problem focused |
5,224 |
4,214 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,268 |
3,538 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,182 |
530 |
$99K |
| D0330 |
Panoramic radiographic image |
3,154 |
2,507 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,846 |
1,615 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
6,985 |
5,497 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,288 |
2,862 |
$61K |
| D1110 |
Prophylaxis - adult |
1,835 |
1,505 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,238 |
1,782 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,460 |
1,163 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
101 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
169 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
849 |
663 |
$11K |
| D1120 |
Prophylaxis - child |
229 |
192 |
$5K |
| D4346 |
|
105 |
101 |
$4K |
| D0270 |
|
428 |
369 |
$3K |
| D4355 |
|
39 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
275 |
231 |
$2K |
| D0272 |
Bitewings - two radiographic images |
156 |
137 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D9986 |
|
12 |
12 |
$0.00 |