| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,665 |
685 |
$266K |
| D0210 |
Intraoral - complete series of radiographic images |
1,901 |
1,901 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,033 |
1,067 |
$136K |
| D1110 |
Prophylaxis - adult |
2,782 |
2,781 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
335 |
$105K |
| D4341 |
|
1,293 |
405 |
$83K |
| D0330 |
Panoramic radiographic image |
2,385 |
2,384 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,315 |
721 |
$31K |
| D2332 |
|
211 |
117 |
$24K |
| D4910 |
|
299 |
299 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,134 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,379 |
2,378 |
$6K |
| D4346 |
|
27 |
27 |
$5K |
| D0274 |
Bitewings - four radiographic images |
3,004 |
3,002 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$750.68 |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,297 |
$131.45 |
| D0120 |
Periodic oral evaluation - established patient |
947 |
947 |
$106.06 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,616 |
2,616 |
$67.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,228 |
627 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
14 |
$0.00 |