| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,813 |
590 |
$335K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,658 |
806 |
$181K |
| D1110 |
Prophylaxis - adult |
2,144 |
2,085 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,466 |
2,414 |
$73K |
| D0330 |
Panoramic radiographic image |
1,419 |
1,387 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,757 |
3,646 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,972 |
3,859 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,764 |
1,722 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,294 |
2,248 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
336 |
$36K |
| D1354 |
|
463 |
60 |
$35K |
| D1120 |
Prophylaxis - child |
994 |
960 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,935 |
3,255 |
$29K |
| D7230 |
|
156 |
56 |
$28K |
| D4341 |
|
180 |
53 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
174 |
106 |
$22K |
| D5214 |
|
15 |
15 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
466 |
458 |
$13K |
| D0350 |
|
313 |
300 |
$9K |
| D1351 |
Sealant - per tooth |
316 |
79 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
38 |
$5K |
| D1320 |
|
110 |
110 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
85 |
85 |
$2K |
| D9310 |
|
40 |
40 |
$2K |
| D4910 |
|
26 |
26 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$219.60 |