| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,930 |
814 |
$243K |
| D0330 |
Panoramic radiographic image |
2,866 |
2,793 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,031 |
704 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,587 |
3,483 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
6,736 |
6,270 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,925 |
2,807 |
$88K |
| D1110 |
Prophylaxis - adult |
1,816 |
1,750 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
481 |
328 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,150 |
5,688 |
$71K |
| D1120 |
Prophylaxis - child |
2,187 |
2,124 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,404 |
2,347 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,620 |
2,499 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,152 |
1,085 |
$35K |
| D5214 |
|
28 |
25 |
$27K |
| D2394 |
|
153 |
112 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
903 |
903 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
74 |
$13K |
| D5213 |
|
12 |
12 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
104 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
208 |
182 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
107 |
$3K |
| D0601 |
|
152 |
152 |
$1K |
| D0602 |
|
75 |
75 |
$686.25 |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
28 |
$674.28 |
| D0603 |
|
61 |
61 |
$558.15 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$292.80 |