| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,322 |
745 |
$184K |
| D1110 |
Prophylaxis - adult |
3,141 |
3,067 |
$166K |
| D0330 |
Panoramic radiographic image |
2,146 |
2,098 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
2,932 |
2,802 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,805 |
974 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,120 |
554 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,676 |
1,644 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
961 |
673 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,867 |
1,824 |
$64K |
| D1120 |
Prophylaxis - child |
1,205 |
1,174 |
$60K |
| D2740 |
Crown - porcelain/ceramic |
70 |
40 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,811 |
1,767 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,790 |
1,737 |
$44K |
| D2330 |
|
616 |
329 |
$44K |
| D7250 |
|
274 |
132 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,027 |
1,924 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,428 |
1,148 |
$24K |
| D2954 |
|
124 |
93 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
116 |
$12K |
| D3310 |
|
22 |
13 |
$11K |
| D7311 |
|
78 |
75 |
$10K |
| D9110 |
|
220 |
211 |
$8K |
| D5212 |
|
12 |
12 |
$7K |
| D3120 |
|
167 |
126 |
$6K |
| D1351 |
Sealant - per tooth |
105 |
29 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
55 |
$4K |
| D2331 |
|
37 |
25 |
$3K |
| D2950 |
|
19 |
14 |
$3K |
| D2332 |
|
16 |
12 |
$2K |
| D9450 |
|
243 |
221 |
$0.00 |
| D1330 |
|
20 |
20 |
$0.00 |