| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
231 |
137 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
884 |
535 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
3,901 |
3,844 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
6,632 |
6,467 |
$82K |
| D1110 |
Prophylaxis - adult |
1,801 |
1,791 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
755 |
236 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,437 |
1,430 |
$58K |
| D7240 |
Removal of impacted tooth - completely bony |
203 |
77 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
165 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,687 |
2,660 |
$43K |
| D0330 |
Panoramic radiographic image |
817 |
812 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,442 |
1,432 |
$35K |
| D7230 |
|
142 |
91 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
424 |
423 |
$31K |
| D0460 |
|
1,109 |
1,099 |
$29K |
| D0274 |
Bitewings - four radiographic images |
968 |
964 |
$29K |
| D9222 |
|
282 |
276 |
$27K |
| D4342 |
|
149 |
57 |
$25K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
284 |
274 |
$24K |
| D0383 |
|
129 |
129 |
$18K |
| D2950 |
|
136 |
83 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
37 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
26 |
$7K |
| D0180 |
|
63 |
63 |
$3K |