| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,652 |
689 |
$193K |
| D1110 |
Prophylaxis - adult |
2,262 |
2,258 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,413 |
2,411 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,417 |
2,411 |
$120K |
| D9430 |
|
2,910 |
2,743 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,202 |
4,767 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,281 |
5,144 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
55 |
37 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
212 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
356 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
75 |
$6K |
| D2330 |
|
62 |
38 |
$5K |
| D5850 |
|
24 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$1K |