| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
851 |
349 |
$135K |
| D1110 |
Prophylaxis - adult |
2,536 |
2,401 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,898 |
1,722 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,991 |
2,829 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,905 |
1,785 |
$58K |
| D2160 |
|
232 |
131 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,363 |
1,292 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
410 |
186 |
$21K |
| D0330 |
Panoramic radiographic image |
455 |
420 |
$21K |
| D1120 |
Prophylaxis - child |
858 |
809 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
390 |
346 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
398 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,257 |
1,069 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
106 |
$3K |
| D0272 |
Bitewings - two radiographic images |
53 |
50 |
$930.16 |