| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,102 |
1,235 |
$272K |
| D1110 |
Prophylaxis - adult |
4,284 |
4,284 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,773 |
1,055 |
$165K |
| D0330 |
Panoramic radiographic image |
2,975 |
2,975 |
$146K |
| D1351 |
Sealant - per tooth |
4,649 |
1,103 |
$137K |
| D1120 |
Prophylaxis - child |
3,822 |
3,822 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,635 |
791 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
5,333 |
5,333 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,995 |
2,995 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,907 |
5,907 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,229 |
2,219 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,622 |
2,622 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
504 |
389 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
773 |
446 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,417 |
1,300 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,200 |
2,128 |
$26K |
| D0272 |
Bitewings - two radiographic images |
939 |
939 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
778 |
778 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
396 |
367 |
$4K |
| D0240 |
|
168 |
160 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$465.60 |