| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,696 |
583 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,510 |
391 |
$128K |
| D7250 |
|
935 |
148 |
$59K |
| D0330 |
Panoramic radiographic image |
2,409 |
1,188 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,403 |
717 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
546 |
154 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,033 |
523 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,349 |
680 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
412 |
120 |
$13K |
| D1110 |
Prophylaxis - adult |
603 |
304 |
$12K |
| D1206 |
Topical application of fluoride varnish |
997 |
509 |
$11K |
| D0274 |
Bitewings - four radiographic images |
733 |
372 |
$6K |
| D7310 |
|
86 |
15 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,034 |
533 |
$5K |
| D7220 |
|
59 |
17 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
383 |
202 |
$5K |
| D0272 |
Bitewings - two radiographic images |
720 |
375 |
$4K |
| D7471 |
|
49 |
12 |
$3K |
| D4342 |
|
165 |
30 |
$3K |
| D1120 |
Prophylaxis - child |
102 |
58 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
604 |
208 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
12 |
$1K |
| D9110 |
|
28 |
14 |
$664.90 |