| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,322 |
512 |
$303K |
| D0330 |
Panoramic radiographic image |
1,513 |
1,449 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
2,491 |
2,345 |
$93K |
| D9310 |
|
1,888 |
1,741 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
428 |
$85K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,245 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,685 |
1,882 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
88 |
56 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,760 |
2,521 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
670 |
605 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
129 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,201 |
1,113 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
738 |
673 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
25 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
129 |
$11K |
| D1120 |
Prophylaxis - child |
268 |
239 |
$10K |
| D1351 |
Sealant - per tooth |
278 |
45 |
$8K |
| D2950 |
|
50 |
28 |
$8K |
| D1320 |
|
293 |
283 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
28 |
$5K |
| D0350 |
|
235 |
226 |
$5K |
| D4341 |
|
32 |
14 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
96 |
$4K |
| D0340 |
|
59 |
58 |
$4K |
| D9630 |
|
178 |
172 |
$2K |
| D0274 |
Bitewings - four radiographic images |
46 |
46 |
$2K |