| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,694 |
1,156 |
$286K |
| D0210 |
Intraoral - complete series of radiographic images |
3,284 |
2,615 |
$162K |
| D1120 |
Prophylaxis - child |
4,876 |
4,038 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,452 |
2,629 |
$103K |
| D1351 |
Sealant - per tooth |
3,936 |
553 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,393 |
3,636 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,719 |
2,079 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
594 |
223 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,036 |
1,843 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,891 |
1,544 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,818 |
2,189 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
459 |
138 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,741 |
2,244 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,215 |
1,563 |
$25K |
| D0330 |
Panoramic radiographic image |
392 |
300 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
27 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
37 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
225 |
196 |
$3K |