| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,749 |
1,147 |
$320K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,536 |
3,521 |
$221K |
| D9430 |
|
6,663 |
5,196 |
$208K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,889 |
1,554 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
3,352 |
3,345 |
$171K |
| D0210 |
Intraoral - complete series of radiographic images |
3,258 |
3,245 |
$151K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
309 |
217 |
$147K |
| D1120 |
Prophylaxis - child |
2,823 |
2,812 |
$105K |
| D8670 |
Periodic orthodontic treatment visit |
396 |
396 |
$104K |
| D4341 |
|
1,334 |
365 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,314 |
4,334 |
$84K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
148 |
116 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,995 |
2,987 |
$62K |
| D2954 |
|
552 |
395 |
$57K |
| D2160 |
|
619 |
415 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,436 |
3,426 |
$36K |
| D2140 |
|
656 |
351 |
$36K |
| D0340 |
|
697 |
697 |
$35K |
| D3320 |
|
69 |
55 |
$25K |
| D0330 |
Panoramic radiographic image |
675 |
675 |
$20K |
| D1110 |
Prophylaxis - adult |
216 |
216 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
491 |
491 |
$17K |
| D2931 |
|
102 |
72 |
$13K |
| D1351 |
Sealant - per tooth |
457 |
113 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
764 |
758 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
40 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
39 |
$4K |
| D4342 |
|
79 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
18 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$150.00 |
| D0270 |
|
14 |
14 |
$70.00 |