| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,845 |
911 |
$630K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,580 |
781 |
$472K |
| D5130 |
|
510 |
501 |
$460K |
| D5140 |
|
454 |
433 |
$409K |
| D5110 |
|
160 |
160 |
$131K |
| D7250 |
|
661 |
128 |
$88K |
| D0330 |
Panoramic radiographic image |
1,348 |
1,310 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,442 |
1,400 |
$46K |
| D5120 |
|
36 |
36 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
88 |
$23K |
| D7310 |
|
105 |
39 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
51 |
$14K |
| D5214 |
|
12 |
12 |
$12K |
| D0274 |
Bitewings - four radiographic images |
78 |
78 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
13 |
$266.70 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$182.88 |