| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,636 |
1,506 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
596 |
320 |
$70K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,211 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,825 |
1,711 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,346 |
1,224 |
$27K |
| D4342 |
|
355 |
144 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
927 |
841 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,796 |
1,621 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
973 |
959 |
$17K |
| D0274 |
Bitewings - four radiographic images |
715 |
707 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,631 |
851 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
120 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
33 |
28 |
$10K |
| D2950 |
|
76 |
71 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
50 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
43 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
240 |
233 |
$4K |
| D7250 |
|
24 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
106 |
106 |
$2K |
| D1120 |
Prophylaxis - child |
68 |
64 |
$2K |
| D9994 |
|
15 |
15 |
$0.00 |