| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,199 |
6,905 |
$596K |
| D9110 |
|
7,077 |
6,879 |
$386K |
| D1120 |
Prophylaxis - child |
5,955 |
5,829 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,725 |
2,586 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,790 |
5,666 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
7,760 |
7,232 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,209 |
4,092 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
14,165 |
13,161 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,234 |
3,167 |
$70K |
| D1351 |
Sealant - per tooth |
865 |
411 |
$60K |
| D5110 |
|
109 |
109 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
974 |
697 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,647 |
2,452 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,132 |
1,098 |
$11K |
| D5120 |
|
25 |
25 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
97 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
141 |
$4K |