| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,136 |
1,957 |
$583K |
| D0120 |
Periodic oral evaluation - established patient |
8,742 |
8,723 |
$451K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,447 |
10,504 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,766 |
3,754 |
$223K |
| D1120 |
Prophylaxis - child |
4,456 |
4,442 |
$154K |
| D0210 |
Intraoral - complete series of radiographic images |
2,422 |
2,418 |
$111K |
| D0272 |
Bitewings - two radiographic images |
8,906 |
8,883 |
$104K |
| D9430 |
|
2,642 |
2,576 |
$82K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
167 |
145 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,754 |
4,486 |
$55K |
| D1110 |
Prophylaxis - adult |
646 |
641 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,355 |
4,342 |
$44K |
| D0330 |
Panoramic radiographic image |
746 |
742 |
$21K |
| D2954 |
|
123 |
109 |
$13K |
| D5750 |
|
53 |
53 |
$10K |
| D4341 |
|
118 |
43 |
$8K |
| D5110 |
|
12 |
12 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
108 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
43 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
96 |
$5K |
| D1351 |
Sealant - per tooth |
186 |
63 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
98 |
$3K |
| D5751 |
|
12 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
38 |
$2K |
| D5520 |
|
16 |
14 |
$1K |
| D0350 |
|
34 |
14 |
$326.40 |