| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,132 |
639 |
$124K |
| D1110 |
Prophylaxis - adult |
2,676 |
2,086 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,436 |
1,821 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,551 |
1,883 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,379 |
1,150 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
804 |
770 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,940 |
1,583 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
73 |
$11K |
| D0330 |
Panoramic radiographic image |
183 |
164 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
137 |
$6K |
| D0272 |
Bitewings - two radiographic images |
189 |
187 |
$4K |
| D1120 |
Prophylaxis - child |
75 |
75 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
94 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
287 |
189 |
$1K |