| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,292 |
1,098 |
$275K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,566 |
1,355 |
$186K |
| D0330 |
Panoramic radiographic image |
3,357 |
3,188 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,307 |
3,154 |
$81K |
| D1110 |
Prophylaxis - adult |
1,635 |
1,551 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,148 |
554 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,740 |
1,633 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
398 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,669 |
2,524 |
$36K |
| D1120 |
Prophylaxis - child |
865 |
808 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,377 |
1,297 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
765 |
$6K |
| D7310 |
|
31 |
12 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
242 |
170 |
$4K |
| D2330 |
|
26 |
13 |
$1K |
| D2331 |
|
27 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79 |
70 |
$396.07 |