| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,815 |
1,208 |
$152K |
| D1110 |
Prophylaxis - adult |
2,697 |
2,692 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,461 |
736 |
$89K |
| D1206 |
Topical application of fluoride varnish |
2,571 |
2,566 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,629 |
2,626 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
504 |
$63K |
| D7250 |
|
410 |
241 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,975 |
1,972 |
$23K |
| D1120 |
Prophylaxis - child |
430 |
429 |
$19K |
| D7230 |
|
88 |
39 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
394 |
393 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
409 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
658 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,794 |
2,786 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,386 |
2,370 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
151 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
457 |
456 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$8K |
| D1351 |
Sealant - per tooth |
310 |
55 |
$6K |
| D0603 |
|
430 |
430 |
$3K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D2954 |
|
22 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$690.00 |