| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,174 |
648 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,041 |
2,026 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
1,605 |
1,599 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,656 |
1,639 |
$76K |
| D1110 |
Prophylaxis - adult |
824 |
811 |
$72K |
| D1120 |
Prophylaxis - child |
1,236 |
1,232 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
641 |
303 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,465 |
1,953 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,251 |
2,235 |
$33K |
| D4341 |
|
306 |
95 |
$19K |
| D0274 |
Bitewings - four radiographic images |
876 |
872 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
260 |
129 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
141 |
$16K |
| D4910 |
|
148 |
148 |
$11K |
| D0350 |
|
1,224 |
563 |
$10K |
| D1351 |
Sealant - per tooth |
316 |
92 |
$9K |
| D2140 |
|
36 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
106 |
$1K |
| D9430 |
|
29 |
25 |
$928.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$153.00 |