| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,356 |
1,417 |
$254K |
| D9310 |
|
3,272 |
3,228 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
810 |
788 |
$43K |
| D0330 |
Panoramic radiographic image |
904 |
891 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
77 |
57 |
$13K |
| D1120 |
Prophylaxis - child |
324 |
313 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
345 |
331 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
278 |
$7K |
| D9243 |
|
12 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
81 |
$5K |
| D1110 |
Prophylaxis - adult |
123 |
112 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
695 |
665 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
187 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
45 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
103 |
$3K |
| D0274 |
Bitewings - four radiographic images |
173 |
163 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
139 |
$2K |
| D9239 |
|
12 |
12 |
$2K |
| D7230 |
|
14 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
223 |
$931.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$771.25 |
| D0272 |
Bitewings - two radiographic images |
67 |
66 |
$592.20 |