| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,464 |
1,598 |
$84K |
| D2740 |
Crown - porcelain/ceramic |
1,560 |
1,002 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
7,793 |
7,211 |
$55K |
| D2950 |
|
2,423 |
1,467 |
$35K |
| D0330 |
Panoramic radiographic image |
3,058 |
2,884 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
11,308 |
10,584 |
$29K |
| D1110 |
Prophylaxis - adult |
2,627 |
2,491 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
572 |
$21K |
| D1120 |
Prophylaxis - child |
2,103 |
2,007 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
3,265 |
3,136 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,996 |
1,887 |
$14K |
| D3320 |
|
174 |
143 |
$13K |
| D0274 |
Bitewings - four radiographic images |
2,677 |
2,562 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
1,059 |
978 |
$11K |
| D1206 |
Topical application of fluoride varnish |
2,331 |
2,220 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
129 |
98 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
423 |
174 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,066 |
3,791 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,153 |
1,126 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
75 |
$3K |
| D0272 |
Bitewings - two radiographic images |
543 |
527 |
$2K |
| D2954 |
|
121 |
95 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
56 |
$2K |
| D7250 |
|
31 |
12 |
$642.18 |
| D2335 |
|
25 |
13 |
$253.88 |
| D1351 |
Sealant - per tooth |
44 |
14 |
$197.44 |
| D2332 |
|
18 |
12 |
$99.85 |
| D1999 |
|
392 |
348 |
$56.93 |
| D1310 |
|
41 |
37 |
$0.00 |
| D1330 |
|
13 |
13 |
$0.00 |