| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,163 |
1,188 |
$253K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,511 |
1,591 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,880 |
2,862 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
2,667 |
2,658 |
$150K |
| D1110 |
Prophylaxis - adult |
1,349 |
1,345 |
$119K |
| D1120 |
Prophylaxis - child |
2,352 |
2,340 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,748 |
1,741 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,481 |
3,953 |
$76K |
| D2160 |
|
793 |
497 |
$63K |
| D2140 |
|
936 |
476 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,515 |
1,511 |
$31K |
| D0350 |
|
3,199 |
1,386 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,970 |
1,961 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,636 |
1,632 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,778 |
1,744 |
$21K |
| D9430 |
|
421 |
410 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
117 |
$13K |
| D0272 |
Bitewings - two radiographic images |
711 |
710 |
$8K |
| D4910 |
|
79 |
79 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
18 |
13 |
$4K |
| D4341 |
|
50 |
13 |
$4K |
| D1351 |
Sealant - per tooth |
57 |
13 |
$2K |