| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16,845 |
6,148 |
$1.95M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,990 |
15,950 |
$987K |
| D0120 |
Periodic oral evaluation - established patient |
13,329 |
13,285 |
$737K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157,347 |
27,405 |
$662K |
| D4341 |
|
8,681 |
2,393 |
$594K |
| D5110 |
|
868 |
865 |
$545K |
| D1110 |
Prophylaxis - adult |
6,271 |
6,237 |
$533K |
| D5130 |
|
650 |
646 |
$407K |
| D1120 |
Prophylaxis - child |
10,109 |
10,076 |
$383K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,498 |
1,689 |
$370K |
| D1351 |
Sealant - per tooth |
12,951 |
2,808 |
$368K |
| D0274 |
Bitewings - four radiographic images |
16,502 |
16,451 |
$350K |
| D4910 |
|
4,831 |
4,807 |
$324K |
| D5120 |
|
382 |
382 |
$240K |
| D5750 |
|
1,229 |
1,219 |
$237K |
| D5140 |
|
354 |
354 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,466 |
16,394 |
$191K |
| D5850 |
|
2,295 |
2,276 |
$159K |
| D5851 |
|
1,711 |
1,695 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,679 |
1,139 |
$112K |
| D5751 |
|
581 |
579 |
$110K |
| D0350 |
|
7,938 |
1,989 |
$72K |
| D0272 |
Bitewings - two radiographic images |
5,594 |
5,567 |
$66K |
| D9430 |
|
1,373 |
1,363 |
$43K |
| D0330 |
Panoramic radiographic image |
1,456 |
1,455 |
$42K |
| D2140 |
|
707 |
443 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,147 |
3,128 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
253 |
$23K |
| D4342 |
|
497 |
175 |
$21K |
| D5214 |
|
30 |
30 |
$20K |
| D1206 |
Topical application of fluoride varnish |
963 |
963 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
60 |
$6K |
| D5520 |
|
20 |
12 |
$1K |
| D0270 |
|
24 |
24 |
$114.05 |