| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,509 |
2,577 |
$408K |
| D1120 |
Prophylaxis - child |
7,151 |
6,713 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
8,459 |
7,918 |
$226K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,893 |
6,476 |
$173K |
| D1351 |
Sealant - per tooth |
2,261 |
1,363 |
$164K |
| D0274 |
Bitewings - four radiographic images |
6,584 |
6,120 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,642 |
780 |
$111K |
| D1110 |
Prophylaxis - adult |
2,454 |
2,283 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,071 |
3,799 |
$86K |
| D9110 |
|
1,577 |
1,436 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,300 |
1,062 |
$75K |
| D0330 |
Panoramic radiographic image |
3,195 |
2,976 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
775 |
662 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,008 |
725 |
$57K |
| D4342 |
|
452 |
269 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
5,586 |
5,155 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,310 |
3,724 |
$29K |
| D2140 |
|
552 |
386 |
$19K |
| D2160 |
|
293 |
222 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,926 |
1,823 |
$18K |
| D5110 |
|
46 |
43 |
$17K |
| D2332 |
|
235 |
169 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
259 |
$12K |
| D4341 |
|
64 |
27 |
$11K |
| D5120 |
|
26 |
26 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
526 |
506 |
$9K |
| D2335 |
|
135 |
108 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
15 |
14 |
$4K |
| D2394 |
|
29 |
26 |
$2K |
| D2331 |
|
37 |
26 |
$2K |
| D9630 |
|
106 |
94 |
$2K |
| D2950 |
|
13 |
12 |
$671.60 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
30 |
$105.20 |
| D1999 |
|
1,444 |
1,109 |
$0.00 |