| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,822 |
1,030 |
$361K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,154 |
1,332 |
$244K |
| D0330 |
Panoramic radiographic image |
3,271 |
3,154 |
$162K |
| D1110 |
Prophylaxis - adult |
2,467 |
2,365 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,381 |
3,253 |
$106K |
| D1120 |
Prophylaxis - child |
3,408 |
3,264 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,263 |
464 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
595 |
435 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,696 |
2,631 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,653 |
3,477 |
$79K |
| D1206 |
Topical application of fluoride varnish |
4,317 |
4,142 |
$77K |
| D1351 |
Sealant - per tooth |
3,131 |
577 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
4,790 |
4,661 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,617 |
3,464 |
$60K |
| D5130 |
|
58 |
58 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,214 |
1,192 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
368 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,052 |
1,023 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
683 |
639 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
896 |
857 |
$14K |
| D5140 |
|
14 |
14 |
$13K |
| D7261 |
|
28 |
28 |
$10K |
| D0602 |
|
473 |
450 |
$4K |
| D4341 |
|
25 |
14 |
$4K |
| D0240 |
|
220 |
220 |
$4K |
| D4342 |
|
31 |
25 |
$3K |
| D0603 |
|
226 |
210 |
$2K |
| D2394 |
|
14 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
49 |
$2K |
| D0601 |
|
113 |
105 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
27 |
$717.58 |