| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,914 |
1,225 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,799 |
2,787 |
$175K |
| D1110 |
Prophylaxis - adult |
1,066 |
1,061 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,557 |
4,369 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,440 |
1,434 |
$73K |
| D9430 |
|
2,264 |
2,125 |
$72K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
141 |
115 |
$67K |
| D1120 |
Prophylaxis - child |
1,540 |
1,531 |
$56K |
| D0330 |
Panoramic radiographic image |
1,716 |
1,712 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,422 |
2,407 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
697 |
529 |
$46K |
| D2140 |
|
764 |
514 |
$41K |
| D1351 |
Sealant - per tooth |
954 |
309 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
412 |
252 |
$23K |
| D0350 |
|
2,076 |
931 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,208 |
1,174 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,348 |
1,340 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
152 |
$13K |
| D0272 |
Bitewings - two radiographic images |
559 |
556 |
$6K |
| D4341 |
|
39 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
30 |
$2K |
| D1206 |
Topical application of fluoride varnish |
127 |
127 |
$2K |
| D2160 |
|
16 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$1K |