| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,619 |
700 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,449 |
855 |
$100K |
| D4910 |
|
1,084 |
1,079 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,214 |
2,194 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,561 |
1,509 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,826 |
2,805 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,004 |
987 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,279 |
1,262 |
$46K |
| D4342 |
|
711 |
311 |
$45K |
| D1110 |
Prophylaxis - adult |
900 |
897 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,413 |
1,403 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,822 |
2,725 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,365 |
1,893 |
$20K |
| D0602 |
|
1,612 |
1,595 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
132 |
$10K |
| D2394 |
|
99 |
81 |
$9K |
| D2331 |
|
128 |
79 |
$9K |
| D1120 |
Prophylaxis - child |
151 |
150 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
51 |
$6K |
| D4341 |
|
69 |
28 |
$5K |
| D0270 |
|
348 |
333 |
$4K |
| D0603 |
|
315 |
311 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
75 |
$2K |
| D2332 |
|
22 |
13 |
$2K |
| D1999 |
|
331 |
251 |
$987.00 |
| D0601 |
|
53 |
53 |
$506.07 |
| D9630 |
|
39 |
38 |
$19.00 |