| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,372 |
654 |
$252K |
| D0210 |
Intraoral - complete series of radiographic images |
1,389 |
1,260 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,907 |
1,804 |
$76K |
| D1110 |
Prophylaxis - adult |
1,033 |
970 |
$44K |
| D0274 |
Bitewings - four radiographic images |
776 |
734 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
237 |
124 |
$22K |
| D0330 |
Panoramic radiographic image |
286 |
269 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
543 |
515 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
250 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
508 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
594 |
286 |
$5K |
| D1206 |
Topical application of fluoride varnish |
202 |
189 |
$4K |
| D4346 |
|
14 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
30 |
$859.05 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$306.42 |