| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,277 |
397 |
$175K |
| D1110 |
Prophylaxis - adult |
3,241 |
2,971 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,136 |
786 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,583 |
2,287 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,952 |
2,701 |
$64K |
| D0330 |
Panoramic radiographic image |
1,291 |
1,108 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
902 |
609 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,496 |
1,293 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
1,852 |
1,167 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,361 |
1,168 |
$13K |
| D2332 |
|
74 |
50 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
68 |
$8K |
| D2330 |
|
34 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
74 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
79 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$232.00 |