| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
243 |
64 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
284 |
185 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
700 |
$43K |
| D1110 |
Prophylaxis - adult |
540 |
540 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
69 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
190 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
119 |
$23K |
| D9243 |
|
41 |
37 |
$20K |
| D1120 |
Prophylaxis - child |
372 |
372 |
$19K |
| D0274 |
Bitewings - four radiographic images |
350 |
350 |
$16K |
| D0330 |
Panoramic radiographic image |
173 |
173 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
327 |
327 |
$13K |
| D1206 |
Topical application of fluoride varnish |
360 |
359 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
193 |
$9K |
| D9239 |
|
41 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
231 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$2K |