| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,231 |
454 |
$132K |
| D0330 |
Panoramic radiographic image |
1,963 |
1,869 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
775 |
509 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,164 |
1,932 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,726 |
1,482 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,680 |
1,659 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
313 |
$42K |
| D1110 |
Prophylaxis - adult |
1,385 |
1,371 |
$42K |
| D1120 |
Prophylaxis - child |
1,258 |
1,249 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,193 |
1,177 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,635 |
1,627 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,082 |
1,882 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
842 |
837 |
$14K |
| D1206 |
Topical application of fluoride varnish |
419 |
416 |
$8K |
| D0272 |
Bitewings - two radiographic images |
312 |
310 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
160 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
14 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
60 |
17 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$1K |
| D9630 |
|
31 |
31 |
$1K |