| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,218 |
372 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,176 |
648 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,924 |
3,839 |
$83K |
| D1120 |
Prophylaxis - child |
2,725 |
2,668 |
$82K |
| D1110 |
Prophylaxis - adult |
1,597 |
1,552 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,826 |
1,754 |
$56K |
| D0330 |
Panoramic radiographic image |
952 |
928 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
187 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,662 |
2,577 |
$46K |
| D0274 |
Bitewings - four radiographic images |
943 |
903 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
788 |
704 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,040 |
1,012 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,164 |
1,100 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
872 |
872 |
$13K |
| D2332 |
|
90 |
39 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
219 |
209 |
$7K |
| D1351 |
Sealant - per tooth |
154 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
108 |
$1K |