| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,928 |
2,911 |
$242K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,986 |
1,070 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
4,216 |
4,191 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,822 |
2,812 |
$172K |
| D1120 |
Prophylaxis - child |
3,336 |
3,323 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,911 |
3,894 |
$81K |
| D1351 |
Sealant - per tooth |
3,233 |
768 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,760 |
6,126 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
890 |
301 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
103 |
79 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,691 |
3,677 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,395 |
1,391 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
315 |
$13K |
| D2954 |
|
103 |
79 |
$11K |
| D0350 |
|
1,123 |
490 |
$10K |
| D2140 |
|
172 |
80 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
125 |
65 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
414 |
404 |
$5K |
| D9430 |
|
118 |
115 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
28 |
$3K |
| D0330 |
Panoramic radiographic image |
114 |
114 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$1K |