| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,272 |
1,217 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
434 |
144 |
$42K |
| D1120 |
Prophylaxis - child |
1,491 |
1,421 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
649 |
611 |
$38K |
| D1351 |
Sealant - per tooth |
1,238 |
207 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
729 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,211 |
1,146 |
$28K |
| D0274 |
Bitewings - four radiographic images |
567 |
528 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
813 |
750 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
14 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
941 |
448 |
$7K |
| D0330 |
Panoramic radiographic image |
150 |
143 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
12 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
17 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
15 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
172 |
151 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
61 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
13 |
$141.80 |