| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
934 |
207 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
976 |
525 |
$95K |
| D1320 |
|
1,880 |
1,778 |
$64K |
| D1110 |
Prophylaxis - adult |
1,257 |
1,246 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,319 |
2,300 |
$46K |
| D0330 |
Panoramic radiographic image |
980 |
976 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,494 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,638 |
2,620 |
$40K |
| D1120 |
Prophylaxis - child |
1,336 |
1,334 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
950 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
66 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
785 |
772 |
$12K |
| D0603 |
|
764 |
751 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
702 |
569 |
$5K |
| D0350 |
|
148 |
148 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
121 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
73 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$1K |
| D0601 |
|
18 |
18 |
$164.70 |
| D0602 |
|
18 |
18 |
$155.55 |