| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
319 |
84 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
330 |
102 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
916 |
902 |
$23K |
| D1120 |
Prophylaxis - child |
475 |
472 |
$18K |
| D1206 |
Topical application of fluoride varnish |
635 |
629 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
359 |
344 |
$13K |
| D0330 |
Panoramic radiographic image |
191 |
189 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
281 |
269 |
$10K |
| D1110 |
Prophylaxis - adult |
170 |
166 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
168 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
15 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$2K |
| D0272 |
Bitewings - two radiographic images |
92 |
90 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
107 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
82 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
32 |
$1K |
| D1330 |
|
54 |
27 |
$0.00 |