| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,246 |
601 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,157 |
2,146 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
2,326 |
2,321 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
218 |
145 |
$104K |
| D1110 |
Prophylaxis - adult |
1,043 |
1,038 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,039 |
1,033 |
$47K |
| D1120 |
Prophylaxis - child |
1,187 |
1,181 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
626 |
358 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,918 |
3,244 |
$36K |
| D9430 |
|
778 |
734 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,901 |
1,889 |
$22K |
| D4341 |
|
237 |
64 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,128 |
1,123 |
$16K |
| D0274 |
Bitewings - four radiographic images |
547 |
547 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
31 |
30 |
$6K |
| D2954 |
|
46 |
39 |
$5K |
| D0330 |
Panoramic radiographic image |
143 |
143 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
27 |
$3K |
| D2140 |
|
42 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
177 |
$2K |
| D1206 |
Topical application of fluoride varnish |
97 |
97 |
$2K |