| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,979 |
1,028 |
$281K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,462 |
1,200 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,591 |
1,192 |
$225K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,137 |
850 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,715 |
3,715 |
$148K |
| D0330 |
Panoramic radiographic image |
2,950 |
2,950 |
$141K |
| D1110 |
Prophylaxis - adult |
2,248 |
2,248 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,685 |
3,685 |
$101K |
| D1120 |
Prophylaxis - child |
2,614 |
2,614 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
962 |
495 |
$76K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,014 |
1,774 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,532 |
2,532 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,548 |
3,548 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
348 |
105 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
163 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,898 |
$36K |
| D2160 |
|
309 |
189 |
$29K |
| D2140 |
|
221 |
115 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
651 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
757 |
675 |
$8K |
| D0272 |
Bitewings - two radiographic images |
404 |
404 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
176 |
174 |
$7K |
| D2394 |
|
18 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
79 |
30 |
$2K |