| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
259 |
173 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
403 |
343 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
384 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
51 |
$6K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$3K |
| D1110 |
Prophylaxis - adult |
31 |
28 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
12 |
$404.36 |