| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,321 |
285 |
$167K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,000 |
244 |
$67K |
| D0330 |
Panoramic radiographic image |
1,089 |
1,069 |
$43K |
| D1110 |
Prophylaxis - adult |
963 |
931 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,167 |
1,147 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,551 |
1,516 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,219 |
1,186 |
$28K |
| D1120 |
Prophylaxis - child |
765 |
752 |
$25K |
| D5110 |
|
30 |
27 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
337 |
150 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
260 |
131 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
543 |
532 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
25 |
12 |
$11K |
| D0274 |
Bitewings - four radiographic images |
340 |
329 |
$9K |
| D5120 |
|
13 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
380 |
$5K |
| D0272 |
Bitewings - two radiographic images |
91 |
90 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
170 |
82 |
$1K |
| D1354 |
|
143 |
41 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
30 |
$965.25 |