| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,109 |
576 |
$278K |
| D0210 |
Intraoral - complete series of radiographic images |
1,618 |
1,618 |
$138K |
| D1110 |
Prophylaxis - adult |
2,045 |
2,043 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,820 |
1,119 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
512 |
395 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,386 |
285 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,221 |
1,199 |
$26K |
| D0330 |
Panoramic radiographic image |
1,926 |
1,922 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,315 |
795 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,368 |
2,367 |
$12K |
| D2332 |
|
53 |
36 |
$10K |
| D2331 |
|
154 |
107 |
$10K |
| D0274 |
Bitewings - four radiographic images |
2,502 |
2,500 |
$6K |
| D4341 |
|
58 |
25 |
$4K |
| D4910 |
|
68 |
67 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,124 |
1,074 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
750 |
$753.63 |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
584 |
$216.42 |
| D2330 |
|
15 |
12 |
$123.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
234 |
$112.13 |