| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
417 |
77 |
$59K |
| D1110 |
Prophylaxis - adult |
518 |
494 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
826 |
761 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,068 |
1,025 |
$26K |
| D1120 |
Prophylaxis - child |
540 |
520 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
998 |
959 |
$20K |
| D0330 |
Panoramic radiographic image |
138 |
130 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
28 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
376 |
253 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
92 |
88 |
$4K |
| D0274 |
Bitewings - four radiographic images |
106 |
102 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$3K |
| D2950 |
|
18 |
14 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
64 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$1K |
| D1999 |
|
231 |
208 |
$0.00 |
| D9986 |
|
101 |
100 |
$0.00 |