| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,948 |
2,450 |
$973K |
| D1110 |
Prophylaxis - adult |
7,100 |
6,795 |
$314K |
| D0330 |
Panoramic radiographic image |
6,010 |
5,654 |
$288K |
| D0274 |
Bitewings - four radiographic images |
9,416 |
9,192 |
$280K |
| D0220 |
Intraoral - periapical first radiographic image |
18,314 |
17,434 |
$270K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,601 |
1,152 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,029 |
1,418 |
$229K |
| D1120 |
Prophylaxis - child |
7,125 |
6,883 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
10,002 |
9,651 |
$207K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,579 |
15,547 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,655 |
4,485 |
$141K |
| D1206 |
Topical application of fluoride varnish |
7,048 |
6,532 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
4,080 |
3,906 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,444 |
5,444 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,751 |
1,611 |
$47K |
| D5214 |
|
47 |
47 |
$44K |
| D5213 |
|
42 |
42 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
373 |
255 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
266 |
116 |
$18K |
| D2394 |
|
76 |
62 |
$12K |
| D5130 |
|
14 |
14 |
$11K |
| D5140 |
|
13 |
13 |
$10K |
| D2140 |
|
103 |
82 |
$6K |
| D7310 |
|
46 |
26 |
$5K |
| D2332 |
|
43 |
28 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
51 |
$3K |
| D5410 |
|
79 |
66 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
81 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
70 |
$2K |
| D2160 |
|
18 |
14 |
$2K |
| D5411 |
|
49 |
39 |
$2K |
| D0601 |
|
132 |
132 |
$1K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$808.46 |
| D3120 |
|
15 |
12 |
$457.50 |
| D0602 |
|
37 |
37 |
$338.55 |
| D0603 |
|
34 |
34 |
$311.10 |