| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,708 |
1,518 |
$319K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
640 |
449 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,392 |
3,388 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
3,238 |
3,229 |
$171K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,670 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,645 |
1,072 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
2,291 |
2,289 |
$109K |
| D4910 |
|
1,147 |
1,145 |
$88K |
| D4341 |
|
952 |
283 |
$67K |
| D1120 |
Prophylaxis - child |
1,715 |
1,710 |
$63K |
| D2954 |
|
516 |
377 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,836 |
2,830 |
$34K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
59 |
55 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,726 |
1,716 |
$19K |
| D2140 |
|
315 |
233 |
$16K |
| D0350 |
|
1,373 |
717 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
796 |
786 |
$9K |
| D0250 |
|
356 |
349 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
58 |
$7K |
| D2160 |
|
90 |
74 |
$7K |
| D1351 |
Sealant - per tooth |
244 |
65 |
$6K |
| D0330 |
Panoramic radiographic image |
218 |
217 |
$6K |
| D3320 |
|
15 |
13 |
$5K |
| D4342 |
|
99 |
37 |
$4K |
| D2330 |
|
42 |
25 |
$3K |
| D9430 |
|
69 |
65 |
$2K |
| D0260 |
|
291 |
271 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
41 |
$720.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
73 |
$364.50 |