| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,921 |
811 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
2,628 |
2,037 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,871 |
2,200 |
$114K |
| D1110 |
Prophylaxis - adult |
2,314 |
1,771 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
930 |
441 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,508 |
1,258 |
$36K |
| D1120 |
Prophylaxis - child |
888 |
882 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
568 |
473 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
689 |
680 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
40 |
$7K |
| D1351 |
Sealant - per tooth |
211 |
82 |
$6K |
| D1206 |
Topical application of fluoride varnish |
205 |
204 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
29 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
40 |
$4K |
| D0274 |
Bitewings - four radiographic images |
102 |
78 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
67 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$581.88 |