| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
759 |
271 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,241 |
1,236 |
$73K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
864 |
468 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,113 |
1,110 |
$51K |
| D2140 |
|
736 |
385 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
919 |
918 |
$34K |
| D1110 |
Prophylaxis - adult |
412 |
410 |
$32K |
| D1120 |
Prophylaxis - child |
1,059 |
1,051 |
$30K |
| D9430 |
|
760 |
700 |
$22K |
| D1351 |
Sealant - per tooth |
910 |
233 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
33 |
30 |
$15K |
| D0274 |
Bitewings - four radiographic images |
788 |
785 |
$15K |
| D2160 |
|
176 |
116 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,112 |
1,243 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,298 |
1,291 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
451 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
31 |
$3K |
| D0272 |
Bitewings - two radiographic images |
81 |
80 |
$849.50 |