| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
923 |
523 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,513 |
1,348 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,700 |
1,510 |
$76K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,204 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,147 |
1,006 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
100 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
36 |
$8K |
| D0274 |
Bitewings - four radiographic images |
156 |
151 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
150 |
111 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
108 |
$1K |
| D0330 |
Panoramic radiographic image |
22 |
13 |
$0.00 |
| D9986 |
|
29 |
22 |
$0.00 |