| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,578 |
1,444 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
4,396 |
4,136 |
$67K |
| D1110 |
Prophylaxis - adult |
951 |
944 |
$63K |
| D1120 |
Prophylaxis - child |
4,185 |
4,030 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,695 |
1,268 |
$63K |
| D9430 |
|
4,874 |
4,572 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,936 |
1,874 |
$53K |
| D1206 |
Topical application of fluoride varnish |
5,779 |
5,596 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,212 |
863 |
$31K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
66 |
53 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
8,360 |
6,961 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,348 |
7,621 |
$18K |
| D4341 |
|
482 |
161 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
831 |
786 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
109 |
$13K |
| D0272 |
Bitewings - two radiographic images |
2,518 |
2,438 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,376 |
1,315 |
$8K |
| D1351 |
Sealant - per tooth |
794 |
301 |
$5K |
| D9993 |
|
156 |
132 |
$1K |
| D0350 |
|
337 |
234 |
$1K |
| D1310 |
|
161 |
133 |
$950.00 |
| D1330 |
|
7,896 |
7,224 |
$0.00 |
| D0603 |
|
38 |
22 |
$0.00 |
| D0270 |
|
103 |
99 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
13 |
$0.00 |
| D1999 |
|
185 |
158 |
$0.00 |