| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,380 |
2,132 |
$952K |
| D1351 |
Sealant - per tooth |
19,954 |
3,429 |
$504K |
| D0210 |
Intraoral - complete series of radiographic images |
6,504 |
6,100 |
$429K |
| D0140 |
Limited oral evaluation - problem focused |
8,172 |
6,936 |
$328K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,779 |
9,809 |
$278K |
| D1110 |
Prophylaxis - adult |
5,294 |
5,057 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,934 |
4,703 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,282 |
7,976 |
$163K |
| D4346 |
|
751 |
736 |
$146K |
| D1120 |
Prophylaxis - child |
4,748 |
4,591 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
6,459 |
6,205 |
$142K |
| D0272 |
Bitewings - two radiographic images |
5,208 |
4,947 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
8,319 |
7,874 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,024 |
1,979 |
$77K |
| D1320 |
|
1,236 |
1,011 |
$49K |
| D7230 |
|
154 |
89 |
$44K |
| D4342 |
|
97 |
26 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$2K |
| D0270 |
|
14 |
14 |
$268.01 |
| D2335 |
|
23 |
15 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
15 |
$0.00 |