| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9310 |
|
2,887 |
2,512 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,930 |
652 |
$146K |
| D4341 |
|
1,506 |
434 |
$88K |
| D0330 |
Panoramic radiographic image |
974 |
974 |
$35K |
| D1110 |
Prophylaxis - adult |
461 |
461 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
996 |
989 |
$14K |
| D4910 |
|
328 |
327 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
387 |
284 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$862.92 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$845.37 |