| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
5,220 |
821 |
$239K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
526 |
200 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,139 |
884 |
$41K |
| D1110 |
Prophylaxis - adult |
948 |
824 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,494 |
1,292 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
740 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
255 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
985 |
794 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,195 |
1,072 |
$22K |
| D1120 |
Prophylaxis - child |
618 |
522 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,695 |
1,408 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
68 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
110 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
415 |
353 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
894 |
452 |
$9K |
| D1351 |
Sealant - per tooth |
339 |
66 |
$8K |
| D0274 |
Bitewings - four radiographic images |
276 |
223 |
$7K |
| D0330 |
Panoramic radiographic image |
97 |
86 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
217 |
174 |
$3K |
| D0272 |
Bitewings - two radiographic images |
19 |
13 |
$272.91 |
| D0350 |
|
176 |
148 |
$0.00 |
| D0431 |
|
467 |
392 |
$0.00 |
| D0801 |
|
17 |
12 |
$0.00 |