| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
476 |
189 |
$51K |
| D1110 |
Prophylaxis - adult |
786 |
760 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,486 |
1,386 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
961 |
872 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
461 |
$16K |
| D0330 |
Panoramic radiographic image |
245 |
224 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
585 |
$9K |
| D0274 |
Bitewings - four radiographic images |
272 |
260 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
139 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$3K |