| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,416 |
1,713 |
$285K |
| D0330 |
Panoramic radiographic image |
3,814 |
3,451 |
$137K |
| D1110 |
Prophylaxis - adult |
2,816 |
2,797 |
$93K |
| D2950 |
|
824 |
582 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
5,665 |
4,934 |
$61K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
129 |
115 |
$55K |
| D7250 |
|
398 |
156 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
772 |
326 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,873 |
2,557 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,550 |
2,528 |
$43K |
| D3320 |
|
144 |
127 |
$37K |
| D9110 |
|
1,358 |
1,271 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
131 |
85 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,895 |
$26K |
| D2394 |
|
216 |
137 |
$22K |
| D2161 |
|
233 |
165 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
1,161 |
999 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,494 |
2,354 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
73 |
$14K |
| D5211 |
|
16 |
16 |
$12K |
| D7311 |
|
148 |
97 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
43 |
$6K |
| D4355 |
|
67 |
67 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
179 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
691 |
461 |
$3K |
| D1354 |
|
1,263 |
660 |
$3K |
| D9994 |
|
1,534 |
1,530 |
$3K |
| D2160 |
|
23 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$402.24 |
| D9630 |
|
1,386 |
1,366 |
$387.45 |
| D7310 |
|
669 |
424 |
$0.00 |
| D0240 |
|
43 |
41 |
$0.00 |
| D9995 |
|
510 |
463 |
$0.00 |
| D5212 |
|
13 |
13 |
$0.00 |
| D4910 |
|
79 |
79 |
$0.00 |
| D2954 |
|
166 |
117 |
$0.00 |
| D2940 |
|
93 |
72 |
$0.00 |
| D9219 |
|
79 |
77 |
$0.00 |
| D4341 |
|
375 |
98 |
$0.00 |
| D9610 |
|
68 |
68 |
$0.00 |
| D2332 |
|
68 |
42 |
$0.00 |