| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,427 |
614 |
$240K |
| D0140 |
Limited oral evaluation - problem focused |
4,448 |
3,547 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
673 |
361 |
$69K |
| D1120 |
Prophylaxis - child |
1,721 |
1,471 |
$58K |
| D0330 |
Panoramic radiographic image |
988 |
856 |
$58K |
| D1110 |
Prophylaxis - adult |
975 |
884 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,160 |
1,865 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,076 |
951 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,607 |
1,389 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
137 |
87 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
387 |
295 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
999 |
849 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
368 |
312 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
58 |
$7K |
| D1351 |
Sealant - per tooth |
294 |
44 |
$6K |
| D0272 |
Bitewings - two radiographic images |
157 |
143 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
27 |
$385.00 |
| D9986 |
|
59 |
56 |
$0.00 |
| D1999 |
|
100 |
65 |
$0.00 |