| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,905 |
1,637 |
$728K |
| D1354 |
|
6,482 |
895 |
$310K |
| D1110 |
Prophylaxis - adult |
2,608 |
2,412 |
$116K |
| D0330 |
Panoramic radiographic image |
2,332 |
2,091 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,258 |
741 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,060 |
1,865 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,108 |
1,910 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,973 |
2,758 |
$62K |
| D4346 |
|
441 |
402 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,217 |
1,102 |
$40K |
| D2394 |
|
340 |
239 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
1,113 |
926 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
233 |
$26K |
| D2335 |
|
165 |
104 |
$25K |
| D1120 |
Prophylaxis - child |
793 |
730 |
$23K |
| D1206 |
Topical application of fluoride varnish |
719 |
680 |
$14K |
| D2332 |
|
91 |
52 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
57 |
$9K |
| D1351 |
Sealant - per tooth |
291 |
43 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
560 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
112 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$370.16 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$288.53 |
| D9986 |
|
108 |
103 |
$0.00 |
| D0603 |
|
405 |
363 |
$0.00 |