| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
456 |
216 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,833 |
1,766 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
505 |
240 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,915 |
2,739 |
$25K |
| D1110 |
Prophylaxis - adult |
861 |
840 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,347 |
1,294 |
$23K |
| D1120 |
Prophylaxis - child |
1,015 |
990 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,358 |
1,327 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,800 |
2,302 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
707 |
685 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
129 |
$11K |
| D0272 |
Bitewings - two radiographic images |
712 |
686 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
369 |
$8K |
| D1206 |
Topical application of fluoride varnish |
270 |
236 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
69 |
$5K |
| D0330 |
Panoramic radiographic image |
156 |
143 |
$5K |
| D1351 |
Sealant - per tooth |
286 |
45 |
$4K |
| D2331 |
|
56 |
40 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
52 |
$1K |
| D2330 |
|
34 |
19 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$933.98 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
13 |
$561.20 |
| D1999 |
|
470 |
397 |
$0.00 |