| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,087 |
498 |
$119K |
| D2740 |
Crown - porcelain/ceramic |
624 |
335 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
852 |
444 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,398 |
710 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,163 |
1,009 |
$54K |
| D7880 |
|
94 |
94 |
$45K |
| D1110 |
Prophylaxis - adult |
1,136 |
1,118 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
684 |
385 |
$38K |
| D4342 |
|
659 |
184 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,558 |
1,511 |
$35K |
| D2394 |
|
205 |
113 |
$29K |
| D2950 |
|
601 |
362 |
$27K |
| D4910 |
|
801 |
791 |
$26K |
| D9630 |
|
1,747 |
1,705 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,117 |
1,068 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
24 |
$22K |
| D5211 |
|
27 |
27 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,312 |
2,075 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,584 |
1,566 |
$20K |
| D5212 |
|
25 |
25 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,860 |
1,128 |
$16K |
| D9994 |
|
2,873 |
2,806 |
$15K |
| D0274 |
Bitewings - four radiographic images |
773 |
759 |
$14K |
| D4341 |
|
404 |
108 |
$14K |
| D1206 |
Topical application of fluoride varnish |
627 |
614 |
$8K |
| D1120 |
Prophylaxis - child |
325 |
325 |
$7K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$3K |
| D2335 |
|
19 |
12 |
$3K |
| D4346 |
|
77 |
77 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
55 |
$1K |
| D4355 |
|
12 |
12 |
$939.36 |
| D9610 |
|
71 |
64 |
$0.00 |
| D9992 |
|
18 |
18 |
$0.00 |