| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,425 |
2,380 |
$637K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,751 |
5,733 |
$376K |
| D1110 |
Prophylaxis - adult |
3,239 |
3,231 |
$282K |
| D0210 |
Intraoral - complete series of radiographic images |
4,893 |
4,871 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
3,478 |
3,443 |
$226K |
| D2740 |
Crown - porcelain/ceramic |
361 |
278 |
$168K |
| D9430 |
|
4,259 |
3,965 |
$135K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,728 |
1,013 |
$113K |
| D0350 |
|
11,177 |
4,621 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,103 |
6,990 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,935 |
695 |
$110K |
| D1120 |
Prophylaxis - child |
2,725 |
2,698 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,386 |
851 |
$91K |
| D4910 |
|
1,043 |
1,040 |
$79K |
| D4341 |
|
1,101 |
319 |
$76K |
| D1206 |
Topical application of fluoride varnish |
4,595 |
4,555 |
$73K |
| D0330 |
Panoramic radiographic image |
2,485 |
2,466 |
$73K |
| D2140 |
|
1,233 |
677 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,968 |
4,579 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,072 |
605 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,318 |
2,299 |
$49K |
| D2330 |
|
479 |
285 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,237 |
2,236 |
$26K |
| D3320 |
|
64 |
55 |
$23K |
| D1351 |
Sealant - per tooth |
759 |
237 |
$20K |
| D1320 |
|
1,062 |
1,059 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
158 |
$16K |
| D2954 |
|
85 |
69 |
$9K |
| D4342 |
|
175 |
61 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D2160 |
|
16 |
12 |
$1K |
| D1310 |
|
24 |
24 |
$1K |
| D0272 |
Bitewings - two radiographic images |
75 |
75 |
$894.00 |
| D9993 |
|
12 |
12 |
$615.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$284.44 |