| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,006 |
3,827 |
$752K |
| D0330 |
Panoramic radiographic image |
10,459 |
8,635 |
$492K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,455 |
8,701 |
$444K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,694 |
2,938 |
$435K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,691 |
1,918 |
$324K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,737 |
462 |
$295K |
| D0120 |
Periodic oral evaluation - established patient |
8,622 |
7,558 |
$212K |
| D1110 |
Prophylaxis - adult |
4,720 |
4,073 |
$205K |
| D1120 |
Prophylaxis - child |
3,944 |
3,895 |
$135K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,343 |
340 |
$110K |
| D0274 |
Bitewings - four radiographic images |
2,927 |
2,565 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
671 |
432 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,582 |
3,519 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,816 |
1,570 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,440 |
1,241 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
2,360 |
2,221 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,207 |
2,030 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,858 |
2,448 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,269 |
1,250 |
$30K |
| D2932 |
|
174 |
52 |
$27K |
| D9420 |
|
258 |
245 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
213 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,234 |
1,184 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
155 |
152 |
$6K |
| D1351 |
Sealant - per tooth |
123 |
36 |
$4K |
| D2931 |
|
20 |
14 |
$2K |
| D2332 |
|
18 |
12 |
$1K |
| D1999 |
|
2,396 |
1,778 |
$81.78 |
| D1330 |
|
31 |
26 |
$0.00 |