| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,355 |
903 |
$120K |
| D1110 |
Prophylaxis - adult |
2,339 |
2,337 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,577 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,162 |
2,161 |
$49K |
| D9310 |
|
1,594 |
1,594 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,060 |
3,979 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,593 |
2,580 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
91 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
65 |
$828.90 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$141.58 |