| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,739 |
945 |
$130K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,679 |
969 |
$105K |
| D1120 |
Prophylaxis - child |
2,228 |
2,092 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,921 |
2,674 |
$75K |
| D1351 |
Sealant - per tooth |
1,185 |
554 |
$61K |
| D2140 |
|
1,328 |
740 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,201 |
2,067 |
$53K |
| D1110 |
Prophylaxis - adult |
1,003 |
914 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,577 |
$35K |
| D2160 |
|
530 |
417 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
701 |
327 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,149 |
1,982 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
5,063 |
4,594 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,990 |
4,075 |
$22K |
| D4341 |
|
52 |
24 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
817 |
731 |
$12K |
| D0330 |
Panoramic radiographic image |
592 |
549 |
$10K |
| D0270 |
|
1,249 |
1,125 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
589 |
548 |
$6K |
| D0272 |
Bitewings - two radiographic images |
530 |
501 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
114 |
105 |
$3K |
| D9110 |
|
65 |
63 |
$3K |
| D2161 |
|
12 |
12 |
$696.60 |