| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,817 |
1,479 |
$467K |
| D5110 |
|
1,020 |
712 |
$395K |
| D5750 |
|
2,187 |
1,924 |
$336K |
| D0140 |
Limited oral evaluation - problem focused |
11,208 |
9,914 |
$326K |
| D5761 |
|
1,502 |
1,305 |
$196K |
| D0330 |
Panoramic radiographic image |
7,594 |
6,409 |
$182K |
| D4355 |
|
3,027 |
2,681 |
$173K |
| D5751 |
|
990 |
895 |
$158K |
| D8660 |
|
4,138 |
3,442 |
$148K |
| D5120 |
|
325 |
230 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,753 |
6,422 |
$127K |
| D5760 |
|
843 |
716 |
$106K |
| D5650 |
|
1,772 |
655 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,326 |
6,635 |
$92K |
| D7311 |
|
936 |
433 |
$91K |
| D5214 |
|
173 |
154 |
$81K |
| D5410 |
|
2,266 |
2,003 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,632 |
3,455 |
$76K |
| D0190 |
|
5,194 |
4,994 |
$64K |
| D0340 |
|
1,850 |
1,228 |
$48K |
| D5422 |
|
1,417 |
1,234 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,843 |
2,415 |
$47K |
| D5899 |
|
1,699 |
1,446 |
$44K |
| D0470 |
|
2,388 |
1,753 |
$41K |
| D9110 |
|
1,216 |
1,008 |
$40K |
| D0350 |
|
2,393 |
1,758 |
$34K |
| D5411 |
|
954 |
865 |
$34K |
| D5630 |
|
295 |
189 |
$31K |
| D5421 |
|
779 |
672 |
$26K |
| D5213 |
|
61 |
59 |
$25K |
| D1120 |
Prophylaxis - child |
710 |
651 |
$20K |
| D1206 |
Topical application of fluoride varnish |
729 |
670 |
$20K |
| D5660 |
|
177 |
134 |
$17K |
| D2140 |
|
396 |
115 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
100 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
557 |
$13K |
| D5512 |
|
307 |
184 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
101 |
$11K |
| D9310 |
|
1,084 |
1,063 |
$7K |
| D1351 |
Sealant - per tooth |
843 |
129 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
466 |
460 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
82 |
29 |
$5K |
| D0240 |
|
397 |
344 |
$4K |
| D5621 |
|
73 |
39 |
$3K |
| D2160 |
|
55 |
29 |
$3K |
| D5612 |
|
113 |
56 |
$3K |
| D7230 |
|
32 |
18 |
$3K |
| D1110 |
Prophylaxis - adult |
168 |
165 |
$2K |
| D5622 |
|
64 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
13 |
$2K |
| D5850 |
|
53 |
51 |
$2K |
| D5511 |
|
75 |
32 |
$2K |
| D5611 |
|
83 |
31 |
$2K |
| D5851 |
|
41 |
36 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
210 |
206 |
$1K |
| D8696 |
|
14 |
14 |
$932.68 |
| D8697 |
|
14 |
13 |
$866.06 |