| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16,765 |
8,411 |
$2.42M |
| D7230 |
|
6,990 |
3,410 |
$1.59M |
| D9243 |
|
17,146 |
5,177 |
$1.46M |
| D7140 |
Extraction, erupted tooth or exposed root |
10,631 |
2,738 |
$1.04M |
| D7250 |
|
5,123 |
2,398 |
$923K |
| D9239 |
|
4,663 |
4,605 |
$585K |
| D0140 |
Limited oral evaluation - problem focused |
14,744 |
14,537 |
$471K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,409 |
3,409 |
$404K |
| D1110 |
Prophylaxis - adult |
10,222 |
10,194 |
$392K |
| D0210 |
Intraoral - complete series of radiographic images |
7,798 |
7,791 |
$341K |
| D0120 |
Periodic oral evaluation - established patient |
11,672 |
11,656 |
$273K |
| D4341 |
|
3,892 |
1,818 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,073 |
9,043 |
$268K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,486 |
14,449 |
$224K |
| D0220 |
Intraoral - periapical first radiographic image |
24,289 |
23,525 |
$176K |
| D2160 |
|
1,902 |
1,453 |
$137K |
| D0274 |
Bitewings - four radiographic images |
11,441 |
11,377 |
$123K |
| D2332 |
|
1,276 |
793 |
$120K |
| D4910 |
|
1,907 |
1,904 |
$109K |
| D1120 |
Prophylaxis - child |
3,398 |
3,392 |
$108K |
| D0330 |
Panoramic radiographic image |
14,187 |
13,978 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,642 |
16,547 |
$91K |
| D3320 |
|
240 |
225 |
$71K |
| D2161 |
|
397 |
367 |
$36K |
| D2140 |
|
561 |
440 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,521 |
1,518 |
$19K |
| D0240 |
|
1,473 |
754 |
$18K |
| D3310 |
|
61 |
53 |
$15K |
| D1999 |
|
1,818 |
1,453 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
137 |
$12K |
| D2331 |
|
142 |
106 |
$9K |
| D2335 |
|
67 |
55 |
$7K |
| D0180 |
|
220 |
220 |
$6K |
| D0601 |
|
1,126 |
1,120 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
56 |
$4K |
| D2330 |
|
69 |
59 |
$4K |
| D1351 |
Sealant - per tooth |
60 |
14 |
$2K |
| D0602 |
|
366 |
365 |
$1K |
| D0603 |
|
195 |
194 |
$682.00 |
| D1330 |
|
1,766 |
1,758 |
$210.00 |
| D1310 |
|
1,782 |
1,772 |
$70.00 |