| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,399 |
646 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
6,997 |
6,193 |
$6K |
| D0274 |
Bitewings - four radiographic images |
4,571 |
4,285 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
2,423 |
2,111 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,615 |
5,009 |
$4K |
| D0330 |
Panoramic radiographic image |
2,249 |
2,089 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
3,276 |
3,114 |
$3K |
| D1110 |
Prophylaxis - adult |
2,045 |
1,942 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,391 |
4,161 |
$2K |
| D1120 |
Prophylaxis - child |
1,759 |
1,708 |
$2K |
| D2740 |
Crown - porcelain/ceramic |
26 |
16 |
$923.54 |
| D2950 |
|
218 |
145 |
$547.86 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
662 |
$436.66 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
843 |
421 |
$347.58 |
| D0210 |
Intraoral - complete series of radiographic images |
300 |
258 |
$321.72 |
| D2954 |
|
15 |
12 |
$212.42 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
58 |
$93.03 |
| D0272 |
Bitewings - two radiographic images |
217 |
205 |
$85.85 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
37 |
$63.70 |
| D0270 |
|
259 |
222 |
$59.67 |
| D1999 |
|
364 |
333 |
$0.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
23 |
12 |
$0.00 |
| D4910 |
|
14 |
14 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$0.00 |