| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,060 |
172 |
$127K |
| D2740 |
Crown - porcelain/ceramic |
130 |
91 |
$69K |
| D1110 |
Prophylaxis - adult |
1,550 |
1,445 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,417 |
1,294 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,484 |
1,355 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
109 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
406 |
247 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,453 |
1,341 |
$29K |
| D5110 |
|
39 |
36 |
$25K |
| D4355 |
|
195 |
182 |
$17K |
| D1120 |
Prophylaxis - child |
491 |
460 |
$15K |
| D1206 |
Topical application of fluoride varnish |
623 |
574 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
378 |
328 |
$10K |
| D0274 |
Bitewings - four radiographic images |
461 |
431 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
297 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
35 |
$4K |
| D7310 |
|
27 |
13 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
36 |
$3K |
| D4342 |
|
33 |
12 |
$1K |
| D1354 |
|
70 |
12 |
$663.97 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
27 |
$315.25 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$187.10 |