| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
338 |
137 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,549 |
1,488 |
$13K |
| D0330 |
Panoramic radiographic image |
372 |
341 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
688 |
331 |
$4K |
| D9310 |
|
359 |
335 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
83 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,911 |
2,819 |
$2K |
| D1110 |
Prophylaxis - adult |
950 |
918 |
$0.00 |
| D0270 |
|
138 |
136 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
932 |
913 |
$0.00 |
| D0191 |
|
108 |
107 |
$0.00 |
| D1120 |
Prophylaxis - child |
776 |
757 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
591 |
398 |
$0.00 |
| D4910 |
|
83 |
79 |
$0.00 |
| D4341 |
|
171 |
85 |
$0.00 |
| D3221 |
|
16 |
14 |
$0.00 |
| D1354 |
|
324 |
96 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,168 |
2,107 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,441 |
1,654 |
$0.00 |
| D0603 |
|
935 |
922 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
684 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
860 |
800 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,362 |
2,265 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,357 |
$0.00 |
| D0602 |
|
478 |
468 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
121 |
119 |
$0.00 |
| D1310 |
|
204 |
200 |
$0.00 |
| D9995 |
|
108 |
107 |
$0.00 |
| D0601 |
|
59 |
58 |
$0.00 |
| D1330 |
|
1,756 |
1,663 |
$0.00 |
| D4346 |
|
43 |
43 |
$0.00 |
| D4342 |
|
98 |
50 |
$0.00 |
| D2331 |
|
39 |
24 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
111 |
84 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
60 |
$0.00 |