| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,643 |
1,479 |
$364K |
| D2740 |
Crown - porcelain/ceramic |
764 |
661 |
$315K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,722 |
634 |
$137K |
| D1110 |
Prophylaxis - adult |
3,002 |
2,909 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,157 |
668 |
$86K |
| D3310 |
|
274 |
205 |
$81K |
| D2950 |
|
749 |
620 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,887 |
2,795 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
2,781 |
2,671 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,395 |
1,370 |
$71K |
| D0330 |
Panoramic radiographic image |
2,951 |
2,852 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
991 |
595 |
$54K |
| D5110 |
|
90 |
87 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,652 |
2,574 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,304 |
$24K |
| D0251 |
|
656 |
592 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,879 |
1,862 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,090 |
1,007 |
$9K |
| D0274 |
Bitewings - four radiographic images |
438 |
423 |
$7K |
| D1120 |
Prophylaxis - child |
268 |
266 |
$7K |
| D5120 |
|
12 |
12 |
$7K |
| D3320 |
|
16 |
14 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
53 |
$5K |
| D4355 |
|
28 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
104 |
72 |
$702.00 |
| D9986 |
|
120 |
116 |
$0.00 |