| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,860 |
1,077 |
$185K |
| D1110 |
Prophylaxis - adult |
2,122 |
2,098 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,846 |
1,032 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,599 |
3,542 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,082 |
2,056 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,800 |
855 |
$86K |
| D2140 |
|
1,440 |
828 |
$70K |
| D1120 |
Prophylaxis - child |
2,865 |
2,849 |
$70K |
| D1351 |
Sealant - per tooth |
4,210 |
1,169 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,060 |
1,053 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,672 |
3,655 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,628 |
2,349 |
$23K |
| D0350 |
|
1,961 |
1,122 |
$16K |
| D9993 |
|
152 |
150 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,256 |
1,202 |
$9K |
| D2160 |
|
110 |
87 |
$9K |
| D0272 |
Bitewings - two radiographic images |
919 |
906 |
$8K |
| D0274 |
Bitewings - four radiographic images |
430 |
426 |
$7K |
| D1310 |
|
152 |
150 |
$6K |
| D9430 |
|
206 |
205 |
$6K |
| D2330 |
|
45 |
29 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
39 |
$3K |
| D2931 |
|
15 |
14 |
$2K |
| D4341 |
|
38 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$422.00 |
| D0603 |
|
13 |
13 |
$195.00 |
| D0601 |
|
12 |
12 |
$90.00 |
| D0270 |
|
12 |
12 |
$45.00 |