| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,449 |
787 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,189 |
556 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
952 |
920 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,298 |
609 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
401 |
224 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
986 |
955 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
428 |
243 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
393 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
194 |
$6K |
| D0274 |
Bitewings - four radiographic images |
365 |
341 |
$5K |
| D1110 |
Prophylaxis - adult |
169 |
149 |
$5K |
| D0330 |
Panoramic radiographic image |
111 |
109 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
543 |
518 |
$3K |