| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,111 |
1,324 |
$441K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,660 |
1,418 |
$186K |
| D1110 |
Prophylaxis - adult |
4,080 |
3,748 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
2,720 |
2,427 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
4,200 |
3,852 |
$86K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,517 |
$51K |
| D0330 |
Panoramic radiographic image |
793 |
733 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,529 |
2,305 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
832 |
490 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,175 |
1,042 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
974 |
893 |
$34K |
| D1120 |
Prophylaxis - child |
1,095 |
987 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,946 |
2,639 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
172 |
$21K |
| D1351 |
Sealant - per tooth |
467 |
91 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
360 |
281 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
657 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
33 |
$8K |
| D2335 |
|
45 |
25 |
$7K |
| D2332 |
|
21 |
13 |
$3K |