| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,544 |
4,704 |
$232K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,274 |
1,574 |
$214K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,119 |
1,163 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,376 |
3,634 |
$172K |
| D0210 |
Intraoral - complete series of radiographic images |
3,331 |
2,759 |
$157K |
| D0330 |
Panoramic radiographic image |
1,610 |
1,432 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
835 |
508 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,862 |
1,528 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,892 |
1,642 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,666 |
2,990 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,600 |
1,285 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
299 |
189 |
$25K |
| D1120 |
Prophylaxis - child |
390 |
389 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
109 |
$9K |
| D0272 |
Bitewings - two radiographic images |
448 |
442 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
392 |
391 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
511 |
414 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
357 |
291 |
$3K |
| D2331 |
|
22 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$315.77 |
| D0270 |
|
34 |
28 |
$312.57 |
| D1999 |
|
364 |
260 |
$0.00 |