| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,339 |
1,368 |
$219K |
| D0330 |
Panoramic radiographic image |
5,517 |
4,892 |
$204K |
| D0140 |
Limited oral evaluation - problem focused |
7,658 |
6,201 |
$127K |
| D1110 |
Prophylaxis - adult |
3,386 |
3,294 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,290 |
3,643 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
8,850 |
7,075 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,664 |
2,604 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,365 |
3,183 |
$45K |
| D9630 |
|
3,028 |
2,540 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
132 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
91 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
638 |
626 |
$10K |
| D7250 |
|
156 |
77 |
$10K |
| D1206 |
Topical application of fluoride varnish |
715 |
712 |
$9K |
| D9310 |
|
94 |
73 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
231 |
153 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
201 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
48 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
24 |
$2K |
| D1120 |
Prophylaxis - child |
128 |
127 |
$2K |
| D1351 |
Sealant - per tooth |
47 |
12 |
$2K |
| D1999 |
|
1,188 |
1,054 |
$0.00 |