| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16,636 |
633 |
$88K |
| D1110 |
Prophylaxis - adult |
29,844 |
2,313 |
$82K |
| D4341 |
|
37,977 |
679 |
$59K |
| D2140 |
|
24,223 |
573 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17,238 |
554 |
$54K |
| D0330 |
Panoramic radiographic image |
27,824 |
2,005 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27,170 |
1,815 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
24,533 |
1,491 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,167 |
1,700 |
$25K |
| D0272 |
Bitewings - two radiographic images |
36,235 |
2,862 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
11,841 |
1,163 |
$23K |
| D1351 |
Sealant - per tooth |
9,660 |
148 |
$14K |
| D1206 |
Topical application of fluoride varnish |
10,896 |
921 |
$12K |
| D1999 |
|
19,384 |
914 |
$9K |
| D1120 |
Prophylaxis - child |
4,461 |
377 |
$7K |
| D2160 |
|
1,211 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
123 |
$766.28 |
| D9999 |
Unspecified adjunctive procedure, by report |
111 |
12 |
$248.22 |