| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,848 |
1,002 |
$156K |
| D1120 |
Prophylaxis - child |
2,799 |
2,630 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,602 |
881 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,327 |
2,190 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,638 |
2,516 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,507 |
4,690 |
$51K |
| D1351 |
Sealant - per tooth |
790 |
412 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,566 |
1,470 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
533 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
2,170 |
2,060 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,984 |
1,884 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,645 |
5,285 |
$31K |
| D0330 |
Panoramic radiographic image |
981 |
941 |
$19K |
| D1110 |
Prophylaxis - adult |
460 |
431 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
262 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
184 |
$5K |
| D5110 |
|
13 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
48 |
$4K |
| D2335 |
|
28 |
26 |
$2K |
| D2950 |
|
34 |
29 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
142 |
$793.10 |
| D0272 |
Bitewings - two radiographic images |
54 |
49 |
$488.80 |