| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,431 |
1,323 |
$283K |
| D1110 |
Prophylaxis - adult |
3,202 |
3,186 |
$274K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,839 |
3,812 |
$240K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,821 |
1,180 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
2,799 |
2,791 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
3,316 |
3,291 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,748 |
1,185 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,189 |
1,141 |
$142K |
| D4910 |
|
1,581 |
1,576 |
$121K |
| D0350 |
|
6,176 |
3,813 |
$118K |
| D1120 |
Prophylaxis - child |
2,027 |
2,017 |
$86K |
| D1206 |
Topical application of fluoride varnish |
5,422 |
5,394 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,238 |
689 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,571 |
3,667 |
$72K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
117 |
86 |
$56K |
| D9430 |
|
1,730 |
1,639 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,533 |
2,525 |
$53K |
| D2740 |
Crown - porcelain/ceramic |
81 |
66 |
$39K |
| D3221 |
|
548 |
379 |
$34K |
| D4341 |
|
335 |
98 |
$23K |
| D2954 |
|
218 |
170 |
$23K |
| D2140 |
|
419 |
222 |
$23K |
| D0330 |
Panoramic radiographic image |
636 |
634 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,313 |
1,277 |
$16K |
| D4342 |
|
247 |
71 |
$10K |
| D2330 |
|
60 |
37 |
$5K |
| D2160 |
|
53 |
38 |
$4K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$588.00 |
| D1999 |
|
23 |
19 |
$10.00 |