| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,355 |
1,182 |
$499K |
| D1110 |
Prophylaxis - adult |
2,131 |
2,056 |
$85K |
| D9310 |
|
2,388 |
2,301 |
$73K |
| D2752 |
|
162 |
103 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,626 |
1,463 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,400 |
1,349 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
961 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,384 |
1,331 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
112 |
$28K |
| D0330 |
Panoramic radiographic image |
592 |
574 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,557 |
1,448 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
664 |
615 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
134 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
185 |
100 |
$14K |
| D1206 |
Topical application of fluoride varnish |
447 |
435 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,005 |
477 |
$8K |
| D2954 |
|
41 |
28 |
$4K |
| D1120 |
Prophylaxis - child |
88 |
84 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
30 |
$1K |
| D0270 |
|
57 |
55 |
$864.96 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$254.20 |