| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
85 |
$20K |
| D9310 |
|
134 |
122 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
42 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
3,915 |
3,645 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
4,616 |
4,309 |
$9.50 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,217 |
585 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,700 |
3,500 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,269 |
2,105 |
$0.00 |
| D1310 |
|
8,058 |
7,431 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,441 |
2,290 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
557 |
398 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
163 |
151 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,098 |
4,696 |
$0.00 |
| D0603 |
|
3,427 |
3,086 |
$0.00 |
| D1330 |
|
9,685 |
8,905 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,467 |
1,385 |
$0.00 |
| D4355 |
|
76 |
73 |
$0.00 |
| D0602 |
|
821 |
770 |
$0.00 |
| D1351 |
Sealant - per tooth |
316 |
95 |
$0.00 |
| D0601 |
|
516 |
480 |
$0.00 |
| D3120 |
|
39 |
25 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
105 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,727 |
2,587 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
956 |
642 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,118 |
1,975 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,952 |
2,806 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
323 |
218 |
$0.00 |
| D0270 |
|
865 |
802 |
$0.00 |
| D1354 |
|
12,082 |
2,779 |
$0.00 |
| D2940 |
|
158 |
127 |
$0.00 |
| D0330 |
Panoramic radiographic image |
244 |
223 |
$0.00 |