| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,195 |
2,371 |
$880K |
| D0140 |
Limited oral evaluation - problem focused |
6,647 |
5,435 |
$171K |
| D1110 |
Prophylaxis - adult |
4,424 |
3,672 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,859 |
895 |
$110K |
| D7250 |
|
614 |
193 |
$89K |
| D0330 |
Panoramic radiographic image |
1,841 |
1,472 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,861 |
2,319 |
$84K |
| D7240 |
Removal of impacted tooth - completely bony |
342 |
96 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,802 |
3,200 |
$69K |
| D2335 |
|
646 |
262 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,854 |
1,507 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
6,380 |
4,988 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
646 |
360 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
536 |
295 |
$36K |
| D1120 |
Prophylaxis - child |
1,236 |
1,060 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
622 |
271 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,350 |
1,219 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,302 |
1,125 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
122 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,107 |
1,274 |
$14K |
| D7310 |
|
231 |
124 |
$13K |
| D2160 |
|
98 |
63 |
$6K |
| D5110 |
|
29 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
164 |
139 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
44 |
$2K |