| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,741 |
594 |
$356K |
| D2740 |
Crown - porcelain/ceramic |
493 |
363 |
$174K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
109 |
99 |
$77K |
| D5110 |
|
109 |
108 |
$72K |
| D7250 |
|
429 |
116 |
$67K |
| D2950 |
|
590 |
463 |
$56K |
| D3320 |
|
97 |
85 |
$52K |
| D0330 |
Panoramic radiographic image |
1,053 |
1,035 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
539 |
$47K |
| D1110 |
Prophylaxis - adult |
1,516 |
1,498 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,400 |
1,157 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,669 |
1,638 |
$41K |
| D5120 |
|
63 |
62 |
$39K |
| D9310 |
|
360 |
354 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,426 |
1,400 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,123 |
1,089 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
215 |
165 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,898 |
1,690 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
299 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,209 |
1,199 |
$13K |
| D1206 |
Topical application of fluoride varnish |
679 |
676 |
$10K |
| D1120 |
Prophylaxis - child |
249 |
248 |
$6K |
| D9630 |
|
262 |
256 |
$4K |
| D7310 |
|
31 |
13 |
$4K |
| D4341 |
|
40 |
15 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
235 |
$3K |
| D4910 |
|
143 |
139 |
$2K |
| D4342 |
|
197 |
74 |
$2K |
| D5212 |
|
12 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
12 |
$0.00 |