| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,017 |
322 |
$78K |
| D2740 |
Crown - porcelain/ceramic |
182 |
99 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,014 |
998 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
793 |
217 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,635 |
1,610 |
$38K |
| D1110 |
Prophylaxis - adult |
1,026 |
1,003 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
174 |
$31K |
| D2950 |
|
256 |
164 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,015 |
1,002 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
604 |
585 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
855 |
822 |
$14K |
| D0274 |
Bitewings - four radiographic images |
476 |
465 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,117 |
1,071 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
98 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
680 |
649 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
41 |
$5K |
| D7250 |
|
56 |
13 |
$4K |
| D4910 |
|
39 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
139 |
$2K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$1K |
| D0601 |
|
91 |
90 |
$305.00 |