| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,091 |
1,954 |
$368K |
| D2740 |
Crown - porcelain/ceramic |
419 |
365 |
$309K |
| D1110 |
Prophylaxis - adult |
3,895 |
3,893 |
$216K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,035 |
696 |
$119K |
| D0274 |
Bitewings - four radiographic images |
4,054 |
4,053 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,721 |
2,720 |
$82K |
| D0330 |
Panoramic radiographic image |
2,448 |
2,445 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,968 |
1,967 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
3,799 |
3,780 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
183 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,971 |
1,944 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
1,042 |
1,030 |
$24K |
| D2140 |
|
202 |
145 |
$15K |
| D2954 |
|
69 |
67 |
$12K |
| D2160 |
|
60 |
30 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
462 |
462 |
$7K |
| D1120 |
Prophylaxis - child |
116 |
116 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
268 |
$3K |
| D1999 |
|
83 |
73 |
$0.00 |