| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,529 |
542 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,528 |
743 |
$174K |
| D1320 |
|
2,256 |
2,155 |
$77K |
| D1110 |
Prophylaxis - adult |
1,609 |
1,538 |
$73K |
| D0330 |
Panoramic radiographic image |
1,467 |
1,416 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
397 |
182 |
$65K |
| D1120 |
Prophylaxis - child |
2,048 |
1,943 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,508 |
3,307 |
$61K |
| D1351 |
Sealant - per tooth |
2,375 |
577 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,264 |
2,178 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,571 |
1,482 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,293 |
1,215 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,245 |
2,089 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,767 |
1,520 |
$22K |
| D0350 |
|
678 |
515 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
629 |
$19K |
| D0272 |
Bitewings - two radiographic images |
601 |
601 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
55 |
$2K |
| D0602 |
|
148 |
148 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$883.92 |
| D0240 |
|
12 |
12 |
$237.77 |