| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,452 |
484 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,919 |
554 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,737 |
1,222 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,347 |
306 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,738 |
1,340 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
464 |
178 |
$20K |
| D1110 |
Prophylaxis - adult |
366 |
308 |
$15K |
| D0274 |
Bitewings - four radiographic images |
387 |
334 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,166 |
918 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
381 |
341 |
$8K |
| D0330 |
Panoramic radiographic image |
344 |
295 |
$8K |
| D4346 |
|
56 |
42 |
$8K |
| D2335 |
|
71 |
13 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
833 |
673 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
332 |
$6K |
| D2394 |
|
48 |
32 |
$5K |
| D2332 |
|
63 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
121 |
$4K |
| D1120 |
Prophylaxis - child |
126 |
91 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
227 |
21 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
93 |
55 |
$708.77 |
| D0272 |
Bitewings - two radiographic images |
76 |
43 |
$570.63 |
| D1999 |
|
17 |
12 |
$0.00 |