| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,891 |
1,088 |
$166K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,346 |
2,119 |
$109K |
| D1120 |
Prophylaxis - child |
2,508 |
2,389 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,602 |
1,291 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,057 |
2,909 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,337 |
936 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,609 |
1,235 |
$66K |
| D1206 |
Topical application of fluoride varnish |
1,755 |
1,699 |
$46K |
| D1110 |
Prophylaxis - adult |
840 |
816 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,610 |
1,554 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,117 |
2,982 |
$31K |
| D1351 |
Sealant - per tooth |
428 |
241 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,275 |
2,129 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
457 |
414 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
273 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
22 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
27 |
$117.80 |