| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,552 |
604 |
$211K |
| D1110 |
Prophylaxis - adult |
2,051 |
2,016 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
870 |
848 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,067 |
2,041 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,967 |
1,665 |
$38K |
| D5211 |
|
65 |
63 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,206 |
2,102 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
884 |
834 |
$33K |
| D5212 |
|
60 |
59 |
$33K |
| D4341 |
|
245 |
87 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
51 |
33 |
$26K |
| D4342 |
|
267 |
108 |
$22K |
| D0272 |
Bitewings - two radiographic images |
730 |
724 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
242 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
197 |
$6K |
| D2335 |
|
45 |
14 |
$5K |
| D9110 |
|
121 |
112 |
$4K |
| D7311 |
|
34 |
27 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |