| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,913 |
2,908 |
$180K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,413 |
765 |
$166K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,012 |
1,054 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
2,577 |
2,569 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,026 |
2,017 |
$110K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
210 |
152 |
$100K |
| D1120 |
Prophylaxis - child |
1,913 |
1,907 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,645 |
4,224 |
$61K |
| D9430 |
|
1,940 |
1,897 |
$58K |
| D2140 |
|
1,081 |
457 |
$57K |
| D0350 |
|
5,044 |
1,844 |
$53K |
| D1110 |
Prophylaxis - adult |
534 |
534 |
$47K |
| D0330 |
Panoramic radiographic image |
1,432 |
1,420 |
$42K |
| D4341 |
|
575 |
170 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
686 |
296 |
$39K |
| D2160 |
|
358 |
234 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,105 |
2,094 |
$24K |
| D0274 |
Bitewings - four radiographic images |
956 |
952 |
$20K |
| D4910 |
|
190 |
190 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
911 |
846 |
$10K |
| D0272 |
Bitewings - two radiographic images |
680 |
680 |
$8K |
| D0270 |
|
1,157 |
1,140 |
$6K |
| D2954 |
|
39 |
27 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
14 |
$836.00 |
| D1330 |
|
2,567 |
2,546 |
$0.00 |