| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,160 |
689 |
$467K |
| D5110 |
|
738 |
611 |
$313K |
| D5120 |
|
284 |
240 |
$126K |
| D7310 |
|
313 |
103 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,685 |
1,531 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,036 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
621 |
118 |
$28K |
| D0330 |
Panoramic radiographic image |
1,025 |
934 |
$28K |
| D1110 |
Prophylaxis - adult |
317 |
283 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
456 |
401 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
71 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,071 |
928 |
$7K |
| D1999 |
|
525 |
399 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
581 |
514 |
$6K |
| D0274 |
Bitewings - four radiographic images |
425 |
376 |
$4K |
| D5751 |
|
16 |
15 |
$2K |
| D5750 |
|
16 |
15 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
618 |
473 |
$924.24 |