| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,246 |
2,924 |
$728K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,673 |
9,641 |
$610K |
| D1110 |
Prophylaxis - adult |
6,503 |
6,476 |
$543K |
| D9430 |
|
12,497 |
11,628 |
$395K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
815 |
667 |
$380K |
| D0120 |
Periodic oral evaluation - established patient |
5,693 |
5,664 |
$355K |
| D0210 |
Intraoral - complete series of radiographic images |
7,583 |
7,554 |
$354K |
| D4341 |
|
4,402 |
1,245 |
$295K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,269 |
2,616 |
$285K |
| D4910 |
|
3,497 |
3,476 |
$262K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
549 |
523 |
$253K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58,534 |
11,249 |
$234K |
| D1120 |
Prophylaxis - child |
4,489 |
4,475 |
$174K |
| D3320 |
|
474 |
433 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,881 |
10,844 |
$142K |
| D1320 |
|
9,526 |
9,467 |
$131K |
| D2140 |
|
2,336 |
1,349 |
$126K |
| D0330 |
Panoramic radiographic image |
3,876 |
3,860 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
9,489 |
9,176 |
$111K |
| D3310 |
|
366 |
268 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,704 |
4,691 |
$97K |
| D2160 |
|
969 |
712 |
$77K |
| D5750 |
|
306 |
301 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
867 |
368 |
$48K |
| D9920 |
|
440 |
394 |
$48K |
| D4342 |
|
1,143 |
405 |
$48K |
| D2954 |
|
396 |
334 |
$40K |
| D0350 |
|
4,114 |
2,401 |
$39K |
| D1351 |
Sealant - per tooth |
1,347 |
333 |
$31K |
| D5751 |
|
115 |
113 |
$22K |
| D1310 |
|
289 |
289 |
$13K |
| D5211 |
|
26 |
26 |
$9K |
| D2330 |
|
87 |
57 |
$6K |
| D1206 |
Topical application of fluoride varnish |
224 |
223 |
$4K |
| D0603 |
|
242 |
242 |
$4K |
| D9993 |
|
42 |
42 |
$3K |
| D9110 |
|
40 |
40 |
$2K |
| D5850 |
|
26 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$2K |
| D0270 |
|
231 |
224 |
$1K |