| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,070 |
1,551 |
$166K |
| D1120 |
Prophylaxis - child |
3,512 |
3,381 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
2,544 |
2,469 |
$142K |
| D1206 |
Topical application of fluoride varnish |
3,494 |
3,367 |
$118K |
| D1351 |
Sealant - per tooth |
5,947 |
604 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,507 |
3,374 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,867 |
3,497 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,651 |
3,533 |
$68K |
| D1110 |
Prophylaxis - adult |
3,385 |
3,275 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,016 |
1,840 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,059 |
4,740 |
$57K |
| D0272 |
Bitewings - two radiographic images |
3,042 |
2,919 |
$51K |
| D0330 |
Panoramic radiographic image |
1,022 |
958 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
427 |
185 |
$16K |
| D2140 |
|
160 |
65 |
$7K |
| D0274 |
Bitewings - four radiographic images |
257 |
244 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
87 |
87 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
29 |
$2K |
| D7241 |
|
92 |
49 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
40 |
40 |
$1K |
| D1999 |
|
35 |
35 |
$510.00 |
| D9630 |
|
177 |
82 |
$140.00 |
| D0602 |
|
12 |
12 |
$16.00 |