| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,208 |
682 |
$175K |
| D0330 |
Panoramic radiographic image |
2,088 |
1,949 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,078 |
417 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,105 |
1,968 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,804 |
1,714 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
331 |
$32K |
| D2160 |
|
437 |
195 |
$29K |
| D1110 |
Prophylaxis - adult |
768 |
739 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
938 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
67 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
127 |
$9K |
| D1206 |
Topical application of fluoride varnish |
408 |
399 |
$7K |
| D1120 |
Prophylaxis - child |
257 |
251 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
276 |
266 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
73 |
$5K |
| D2331 |
|
61 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
249 |
247 |
$4K |
| D2140 |
|
72 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
155 |
152 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
264 |
$2K |
| D2161 |
|
27 |
14 |
$2K |
| D2330 |
|
31 |
12 |
$1K |
| D0180 |
|
1,387 |
1,072 |
$1K |
| D0270 |
|
130 |
119 |
$766.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
15 |
$114.40 |
| D1330 |
|
32 |
27 |
$98.25 |
| D2394 |
|
19 |
13 |
$78.94 |
| D3120 |
|
23 |
12 |
$0.00 |