| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,944 |
2,219 |
$499K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,064 |
4,855 |
$255K |
| D2161 |
|
1,870 |
1,115 |
$223K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,940 |
1,209 |
$182K |
| D0330 |
Panoramic radiographic image |
3,080 |
2,784 |
$168K |
| D4355 |
|
2,415 |
2,214 |
$153K |
| D2160 |
|
1,424 |
934 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,131 |
2,831 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,963 |
3,648 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
7,728 |
6,736 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,157 |
3,912 |
$101K |
| D1110 |
Prophylaxis - adult |
2,686 |
2,505 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,709 |
5,747 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,752 |
3,520 |
$60K |
| D1351 |
Sealant - per tooth |
2,176 |
578 |
$59K |
| D1120 |
Prophylaxis - child |
1,789 |
1,673 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
221 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,151 |
1,037 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
579 |
306 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
233 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,170 |
1,093 |
$21K |
| D1206 |
Topical application of fluoride varnish |
516 |
476 |
$8K |
| D2331 |
|
73 |
38 |
$6K |
| D2332 |
|
27 |
13 |
$3K |
| D2140 |
|
15 |
12 |
$1K |
| D3120 |
|
379 |
259 |
$0.00 |