| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,418 |
1,109 |
$550K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,791 |
1,193 |
$277K |
| D0330 |
Panoramic radiographic image |
5,047 |
4,898 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,200 |
1,536 |
$237K |
| D0274 |
Bitewings - four radiographic images |
7,136 |
7,052 |
$208K |
| D1110 |
Prophylaxis - adult |
4,721 |
4,612 |
$202K |
| D0220 |
Intraoral - periapical first radiographic image |
12,200 |
11,694 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
7,908 |
7,744 |
$158K |
| D1120 |
Prophylaxis - child |
5,158 |
5,061 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,148 |
10,434 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,767 |
3,660 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,461 |
3,403 |
$102K |
| D1206 |
Topical application of fluoride varnish |
4,353 |
4,161 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,638 |
4,638 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,202 |
1,992 |
$59K |
| D5130 |
|
41 |
41 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
95 |
$12K |
| D5140 |
|
13 |
13 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
63 |
$10K |
| D2160 |
|
56 |
41 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
58 |
$4K |
| D0272 |
Bitewings - two radiographic images |
214 |
214 |
$4K |
| D2394 |
|
16 |
13 |
$3K |
| D5410 |
|
53 |
40 |
$2K |
| D3120 |
|
43 |
30 |
$1K |
| D0602 |
|
116 |
116 |
$1K |
| D5411 |
|
18 |
13 |
$646.26 |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
17 |
$475.53 |