| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,647 |
804 |
$188K |
| D1110 |
Prophylaxis - adult |
1,797 |
1,787 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,857 |
1,853 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,286 |
2,284 |
$92K |
| D4341 |
|
1,298 |
363 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,737 |
1,728 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,616 |
3,246 |
$69K |
| D1120 |
Prophylaxis - child |
1,780 |
1,770 |
$52K |
| D2140 |
|
767 |
492 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
594 |
425 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,812 |
1,803 |
$37K |
| D1351 |
Sealant - per tooth |
1,664 |
429 |
$35K |
| D9430 |
|
865 |
858 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
444 |
228 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,177 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
20 |
14 |
$10K |
| D0272 |
Bitewings - two radiographic images |
193 |
193 |
$2K |
| D2330 |
|
22 |
14 |
$2K |
| D0350 |
|
62 |
30 |
$624.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$216.00 |
| D1999 |
|
339 |
331 |
$20.00 |