| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0340 |
|
3,506 |
3,464 |
$164K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,256 |
777 |
$148K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
187 |
148 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,744 |
1,728 |
$79K |
| D0330 |
Panoramic radiographic image |
2,625 |
2,605 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,121 |
1,109 |
$71K |
| D1110 |
Prophylaxis - adult |
588 |
588 |
$53K |
| D8670 |
Periodic orthodontic treatment visit |
165 |
165 |
$45K |
| D9430 |
|
1,338 |
1,319 |
$43K |
| D4910 |
|
395 |
395 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
53 |
51 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,327 |
1,323 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
158 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,778 |
1,727 |
$15K |
| D7230 |
|
80 |
44 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
260 |
99 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
179 |
177 |
$12K |
| D0290 |
|
268 |
263 |
$9K |
| D1120 |
Prophylaxis - child |
183 |
183 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
699 |
689 |
$8K |
| D0350 |
|
741 |
509 |
$6K |
| D0272 |
Bitewings - two radiographic images |
458 |
456 |
$5K |
| D2954 |
|
46 |
44 |
$5K |
| D3320 |
|
12 |
12 |
$4K |
| D4341 |
|
52 |
13 |
$4K |
| D0274 |
Bitewings - four radiographic images |
137 |
136 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$752.50 |