| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12,960 |
3,369 |
$1.31M |
| D2740 |
Crown - porcelain/ceramic |
706 |
631 |
$273K |
| D1110 |
Prophylaxis - adult |
6,493 |
6,416 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,679 |
1,969 |
$255K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,747 |
11,497 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
3,027 |
3,009 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
7,098 |
7,030 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
4,874 |
4,767 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,941 |
4,775 |
$119K |
| D1120 |
Prophylaxis - child |
4,206 |
4,061 |
$113K |
| D0330 |
Panoramic radiographic image |
3,666 |
3,583 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,898 |
547 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,895 |
975 |
$92K |
| D4341 |
|
884 |
280 |
$85K |
| D1351 |
Sealant - per tooth |
3,297 |
489 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,011 |
656 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,538 |
3,480 |
$72K |
| D2950 |
|
577 |
516 |
$48K |
| D2332 |
|
626 |
313 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,388 |
1,265 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,818 |
2,754 |
$29K |
| D4910 |
|
306 |
304 |
$19K |
| D7240 |
Removal of impacted tooth - completely bony |
118 |
33 |
$13K |
| D5110 |
|
17 |
16 |
$9K |
| D0272 |
Bitewings - two radiographic images |
566 |
564 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
134 |
131 |
$3K |
| D0602 |
|
418 |
417 |
$2K |
| D1354 |
|
327 |
121 |
$1K |
| D0601 |
|
165 |
162 |
$755.00 |
| D0603 |
|
55 |
53 |
$260.00 |