| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,336 |
2,263 |
$506K |
| D2740 |
Crown - porcelain/ceramic |
620 |
417 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,540 |
4,512 |
$286K |
| D4341 |
|
2,724 |
752 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
4,130 |
4,104 |
$186K |
| D1110 |
Prophylaxis - adult |
2,048 |
2,040 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
1,077 |
1,071 |
$67K |
| D4910 |
|
606 |
606 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
412 |
$40K |
| D9430 |
|
1,007 |
952 |
$31K |
| D3320 |
|
63 |
58 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
27 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,130 |
918 |
$12K |
| D2954 |
|
85 |
61 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
80 |
$9K |
| D1206 |
Topical application of fluoride varnish |
426 |
426 |
$7K |
| D2952 |
|
64 |
47 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
538 |
$6K |
| D5520 |
|
92 |
32 |
$6K |
| D5750 |
|
30 |
29 |
$5K |
| D5751 |
|
26 |
26 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
53 |
$5K |
| D3310 |
|
16 |
13 |
$5K |
| D5410 |
|
146 |
145 |
$5K |
| D4342 |
|
113 |
33 |
$5K |
| D0274 |
Bitewings - four radiographic images |
209 |
209 |
$4K |
| D5411 |
|
128 |
128 |
$4K |
| D0330 |
Panoramic radiographic image |
105 |
105 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
194 |
193 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$1K |
| D3221 |
|
15 |
14 |
$945.00 |