| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,992 |
1,579 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,974 |
1,047 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,669 |
4,532 |
$227K |
| D1110 |
Prophylaxis - adult |
4,759 |
3,977 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,933 |
1,069 |
$195K |
| D0210 |
Intraoral - complete series of radiographic images |
3,343 |
2,867 |
$129K |
| D0274 |
Bitewings - four radiographic images |
6,098 |
4,508 |
$118K |
| D0330 |
Panoramic radiographic image |
3,932 |
3,241 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,496 |
3,636 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
124 |
$23K |
| D0272 |
Bitewings - two radiographic images |
845 |
832 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
697 |
691 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
93 |
$12K |
| D1120 |
Prophylaxis - child |
244 |
242 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
336 |
309 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
88 |
$3K |
| D1351 |
Sealant - per tooth |
41 |
13 |
$993.87 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
16 |
$795.52 |