| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,280 |
1,655 |
$700K |
| D1206 |
Topical application of fluoride varnish |
3,722 |
3,661 |
$193K |
| D4341 |
|
1,779 |
454 |
$177K |
| D4355 |
|
2,151 |
2,117 |
$152K |
| D1120 |
Prophylaxis - child |
2,773 |
2,732 |
$152K |
| D2740 |
Crown - porcelain/ceramic |
323 |
190 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
4,282 |
4,062 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,485 |
6,811 |
$117K |
| D0350 |
|
5,753 |
959 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,165 |
536 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
6,539 |
6,241 |
$95K |
| D7910 |
|
3,497 |
679 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,978 |
3,864 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,763 |
2,694 |
$83K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,071 |
3,663 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
1,973 |
$62K |
| D2950 |
|
374 |
230 |
$43K |
| D0330 |
Panoramic radiographic image |
1,102 |
1,066 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,645 |
1,613 |
$32K |
| D0240 |
|
1,422 |
1,402 |
$19K |
| D1110 |
Prophylaxis - adult |
382 |
368 |
$17K |
| D5130 |
|
27 |
27 |
$17K |
| D2140 |
|
111 |
62 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$1K |
| D5410 |
|
16 |
16 |
$655.84 |
| D5411 |
|
12 |
12 |
$491.88 |
| D0270 |
|
56 |
55 |
$462.76 |
| D0170 |
|
31 |
27 |
$405.68 |