| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
729 |
262 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,894 |
1,288 |
$56K |
| D1120 |
Prophylaxis - child |
993 |
949 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,813 |
1,732 |
$36K |
| D1110 |
Prophylaxis - adult |
1,065 |
1,011 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,147 |
1,086 |
$32K |
| D0330 |
Panoramic radiographic image |
559 |
536 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
375 |
249 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
858 |
815 |
$23K |
| D0274 |
Bitewings - four radiographic images |
775 |
730 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
461 |
434 |
$22K |
| D8670 |
Periodic orthodontic treatment visit |
549 |
530 |
$18K |
| D1206 |
Topical application of fluoride varnish |
361 |
341 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
179 |
168 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
68 |
$6K |
| D7230 |
|
25 |
15 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
358 |
331 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
324 |
186 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
99 |
97 |
$3K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$2K |
| D1330 |
|
14 |
14 |
$0.00 |