| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,357 |
478 |
$104K |
| D1110 |
Prophylaxis - adult |
2,105 |
1,737 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,351 |
1,142 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,080 |
905 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,014 |
839 |
$23K |
| D0274 |
Bitewings - four radiographic images |
621 |
510 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
206 |
$4K |
| D1120 |
Prophylaxis - child |
120 |
119 |
$4K |
| D0272 |
Bitewings - two radiographic images |
182 |
177 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
54 |
$911.88 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$829.66 |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
55 |
$519.15 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$440.76 |