| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,981 |
962 |
$183K |
| D1110 |
Prophylaxis - adult |
2,803 |
2,649 |
$97K |
| D0330 |
Panoramic radiographic image |
2,671 |
2,529 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,902 |
3,679 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,105 |
1,953 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,631 |
2,450 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,577 |
665 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
753 |
456 |
$38K |
| D4341 |
|
454 |
148 |
$28K |
| D1120 |
Prophylaxis - child |
541 |
503 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,217 |
1,167 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
313 |
197 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
280 |
273 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,516 |
2,295 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,008 |
1,374 |
$13K |
| D2394 |
|
134 |
83 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
84 |
$5K |
| D7310 |
|
33 |
13 |
$2K |
| D2332 |
|
36 |
25 |
$2K |
| D7250 |
|
20 |
13 |
$2K |
| D9110 |
|
27 |
25 |
$546.57 |
| D0272 |
Bitewings - two radiographic images |
45 |
45 |
$530.44 |