| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,765 |
449 |
$277K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,101 |
1,524 |
$201K |
| D1110 |
Prophylaxis - adult |
4,161 |
3,861 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
2,023 |
1,843 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,198 |
704 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
4,104 |
3,837 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,167 |
1,969 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,136 |
1,973 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,334 |
1,227 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
410 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,258 |
1,201 |
$23K |
| D0330 |
Panoramic radiographic image |
444 |
410 |
$22K |
| D1120 |
Prophylaxis - child |
505 |
482 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,199 |
1,103 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
62 |
$9K |
| D0272 |
Bitewings - two radiographic images |
263 |
242 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
54 |
48 |
$1K |