| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,286 |
1,359 |
$515K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,505 |
2,335 |
$390K |
| D1110 |
Prophylaxis - adult |
6,724 |
6,463 |
$298K |
| D0274 |
Bitewings - four radiographic images |
10,021 |
9,765 |
$298K |
| D0330 |
Panoramic radiographic image |
5,615 |
5,371 |
$265K |
| D0220 |
Intraoral - periapical first radiographic image |
17,924 |
17,136 |
$264K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,739 |
1,120 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
10,962 |
10,582 |
$227K |
| D1120 |
Prophylaxis - child |
7,125 |
6,894 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,754 |
16,030 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,444 |
4,292 |
$133K |
| D1206 |
Topical application of fluoride varnish |
7,083 |
6,606 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
3,017 |
2,938 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,574 |
5,574 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,158 |
1,089 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
517 |
335 |
$31K |
| D7230 |
|
122 |
39 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
117 |
$12K |
| D2394 |
|
39 |
29 |
$5K |
| D3120 |
|
135 |
63 |
$4K |
| D7310 |
|
22 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
44 |
$1K |
| D0601 |
|
41 |
41 |
$375.15 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$366.00 |