| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,743 |
3,766 |
$781K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12,142 |
5,224 |
$702K |
| D1110 |
Prophylaxis - adult |
13,677 |
13,101 |
$607K |
| D4341 |
|
15,653 |
4,958 |
$522K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,234 |
3,549 |
$389K |
| D2140 |
|
8,291 |
3,685 |
$366K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,749 |
16,046 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
10,204 |
10,018 |
$279K |
| D2160 |
|
3,581 |
2,137 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,067 |
6,512 |
$237K |
| D3310 |
|
749 |
392 |
$228K |
| D7250 |
|
1,940 |
622 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
20,332 |
19,003 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,565 |
1,720 |
$172K |
| D2331 |
|
2,435 |
1,445 |
$154K |
| D0274 |
Bitewings - four radiographic images |
12,773 |
12,218 |
$146K |
| D1351 |
Sealant - per tooth |
6,760 |
1,594 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
5,062 |
4,711 |
$128K |
| D2330 |
|
2,915 |
1,494 |
$128K |
| D9110 |
|
1,513 |
1,429 |
$92K |
| D2335 |
|
791 |
529 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,382 |
16,401 |
$73K |
| D1120 |
Prophylaxis - child |
3,225 |
3,107 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
744 |
460 |
$57K |
| D5110 |
|
66 |
65 |
$48K |
| D0330 |
Panoramic radiographic image |
1,434 |
1,343 |
$41K |
| D9920 |
|
906 |
841 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,485 |
2,407 |
$22K |
| D9930 |
|
207 |
178 |
$10K |
| D5120 |
|
12 |
12 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
171 |
$8K |
| D2332 |
|
105 |
66 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
33 |
$5K |
| D2161 |
|
15 |
13 |
$987.12 |
| D0270 |
|
12 |
12 |
$66.24 |