| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,634 |
663 |
$186K |
| D0330 |
Panoramic radiographic image |
1,691 |
1,569 |
$84K |
| D1110 |
Prophylaxis - adult |
1,964 |
1,920 |
$79K |
| D2740 |
Crown - porcelain/ceramic |
132 |
85 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,716 |
3,350 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,309 |
$60K |
| D2950 |
|
541 |
375 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,162 |
2,130 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,009 |
3,734 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,657 |
1,628 |
$36K |
| D1120 |
Prophylaxis - child |
1,135 |
1,127 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,809 |
1,785 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,509 |
1,395 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
346 |
174 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
2,691 |
978 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
38 |
$16K |
| D9920 |
|
285 |
280 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
135 |
$15K |
| D5110 |
|
14 |
14 |
$9K |
| D5120 |
|
12 |
12 |
$8K |
| D9994 |
|
1,210 |
1,172 |
$6K |
| D2330 |
|
57 |
25 |
$1K |