| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,624 |
1,058 |
$535K |
| D1354 |
|
2,421 |
895 |
$177K |
| D1110 |
Prophylaxis - adult |
3,795 |
3,552 |
$175K |
| D0330 |
Panoramic radiographic image |
2,450 |
2,291 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,911 |
4,663 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,990 |
2,739 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,114 |
2,928 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,342 |
781 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,489 |
4,190 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,349 |
2,183 |
$78K |
| D1120 |
Prophylaxis - child |
2,582 |
2,409 |
$76K |
| D1351 |
Sealant - per tooth |
2,896 |
378 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,736 |
4,046 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,524 |
4,214 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
402 |
245 |
$34K |
| D2160 |
|
340 |
218 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,135 |
964 |
$29K |
| D4346 |
|
153 |
142 |
$22K |
| D5110 |
|
53 |
52 |
$17K |
| D0272 |
Bitewings - two radiographic images |
781 |
720 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
96 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
645 |
396 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
98 |
$9K |
| D1206 |
Topical application of fluoride varnish |
368 |
351 |
$9K |
| D2332 |
|
50 |
27 |
$6K |
| D2335 |
|
46 |
27 |
$4K |
| D0240 |
|
397 |
173 |
$4K |
| D2331 |
|
30 |
24 |
$3K |
| D2140 |
|
32 |
25 |
$2K |
| D4212 |
|
20 |
14 |
$798.12 |
| D0160 |
|
16 |
14 |
$782.00 |