| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,282 |
500 |
$210K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,518 |
1,270 |
$192K |
| D0210 |
Intraoral - complete series of radiographic images |
1,993 |
1,767 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,851 |
2,615 |
$87K |
| D0330 |
Panoramic radiographic image |
1,556 |
1,486 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,312 |
1,243 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
503 |
281 |
$29K |
| D1110 |
Prophylaxis - adult |
409 |
389 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
76 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
83 |
$8K |
| D7250 |
|
32 |
12 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
16 |
$6K |
| D0274 |
Bitewings - four radiographic images |
334 |
309 |
$5K |
| D2394 |
|
48 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
495 |
439 |
$3K |
| D2335 |
|
25 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
174 |
89 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$441.08 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
34 |
$386.90 |