| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,651 |
2,862 |
$391K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,917 |
1,575 |
$247K |
| D1351 |
Sealant - per tooth |
3,769 |
1,313 |
$219K |
| D1120 |
Prophylaxis - child |
4,931 |
4,829 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,548 |
5,250 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,213 |
6,042 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,903 |
1,570 |
$115K |
| D0274 |
Bitewings - four radiographic images |
6,276 |
5,962 |
$99K |
| D1110 |
Prophylaxis - adult |
2,211 |
2,136 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,522 |
3,453 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,175 |
9,322 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
10,998 |
10,449 |
$66K |
| D0330 |
Panoramic radiographic image |
2,487 |
2,434 |
$55K |
| D4341 |
|
269 |
146 |
$40K |
| D5110 |
|
65 |
65 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,364 |
1,347 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
537 |
449 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
242 |
207 |
$16K |
| D5120 |
|
26 |
26 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
25 |
$2K |
| D2331 |
|
13 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
47 |
$1K |
| D0272 |
Bitewings - two radiographic images |
108 |
108 |
$1K |
| D9110 |
|
13 |
13 |
$715.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$143.10 |