| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,968 |
567 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,465 |
2,418 |
$55K |
| D0330 |
Panoramic radiographic image |
1,478 |
1,459 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,060 |
3,934 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,675 |
1,569 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
883 |
838 |
$45K |
| D0160 |
|
1,807 |
1,466 |
$36K |
| D1120 |
Prophylaxis - child |
654 |
637 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
865 |
701 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,866 |
3,186 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
792 |
680 |
$12K |
| D1206 |
Topical application of fluoride varnish |
302 |
297 |
$10K |
| D1351 |
Sealant - per tooth |
359 |
41 |
$7K |
| D1110 |
Prophylaxis - adult |
198 |
193 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
25 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
186 |
176 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$986.91 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
43 |
$977.32 |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
29 |
$870.00 |
| D3120 |
|
47 |
17 |
$756.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
17 |
$340.00 |
| D9310 |
|
15 |
15 |
$123.00 |