| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,938 |
2,111 |
$409K |
| D1110 |
Prophylaxis - adult |
5,086 |
5,086 |
$251K |
| D0330 |
Panoramic radiographic image |
3,234 |
3,233 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
5,512 |
5,512 |
$125K |
| D0274 |
Bitewings - four radiographic images |
4,236 |
4,236 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,792 |
2,792 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,163 |
718 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,534 |
4,534 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,454 |
1,420 |
$54K |
| D1120 |
Prophylaxis - child |
1,392 |
1,392 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,409 |
2,409 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,678 |
2,639 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
775 |
748 |
$25K |
| D7220 |
|
73 |
63 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
160 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$1K |