| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,448 |
1,631 |
$335K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,000 |
348 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,855 |
917 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,496 |
1,452 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
721 |
694 |
$10K |
| D1110 |
Prophylaxis - adult |
223 |
217 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
384 |
383 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
28 |
$5K |
| D1120 |
Prophylaxis - child |
173 |
173 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
323 |
323 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
245 |
241 |
$4K |
| D0274 |
Bitewings - four radiographic images |
121 |
119 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$873.69 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |