| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,935 |
733 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,494 |
2,479 |
$162K |
| D1110 |
Prophylaxis - adult |
1,515 |
1,502 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
1,447 |
1,434 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
622 |
617 |
$44K |
| D1120 |
Prophylaxis - child |
880 |
878 |
$37K |
| D0330 |
Panoramic radiographic image |
1,130 |
1,130 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
135 |
56 |
$30K |
| D9430 |
|
917 |
910 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,633 |
1,621 |
$23K |
| D0274 |
Bitewings - four radiographic images |
900 |
892 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
35 |
25 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,055 |
1,216 |
$12K |
| D1206 |
Topical application of fluoride varnish |
693 |
692 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
200 |
200 |
$8K |
| D7230 |
|
31 |
13 |
$6K |
| D2952 |
|
18 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$586.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$132.00 |