| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,986 |
1,888 |
$461K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,166 |
2,185 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
6,319 |
6,301 |
$331K |
| D1120 |
Prophylaxis - child |
6,209 |
6,196 |
$230K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
363 |
270 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,433 |
2,425 |
$150K |
| D1351 |
Sealant - per tooth |
5,003 |
1,293 |
$124K |
| D1110 |
Prophylaxis - adult |
1,262 |
1,253 |
$104K |
| D2160 |
|
1,252 |
792 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
2,114 |
2,108 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,363 |
4,354 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,249 |
8,806 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,613 |
7,591 |
$86K |
| D9430 |
|
2,118 |
2,025 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,345 |
4,216 |
$50K |
| D2140 |
|
568 |
358 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
50 |
48 |
$23K |
| D0350 |
|
1,995 |
1,063 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,490 |
1,487 |
$17K |
| D4341 |
|
133 |
38 |
$9K |
| D2330 |
|
109 |
52 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
64 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$7K |
| D9110 |
|
64 |
62 |
$4K |
| D7111 |
|
65 |
30 |
$4K |
| D9993 |
|
44 |
44 |
$3K |
| D1310 |
|
44 |
44 |
$2K |
| D4910 |
|
27 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$940.80 |
| D1330 |
|
242 |
239 |
$0.00 |