| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,810 |
1,348 |
$331K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,519 |
1,959 |
$304K |
| D2330 |
|
3,794 |
1,818 |
$293K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,338 |
4,323 |
$269K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
522 |
388 |
$253K |
| D1110 |
Prophylaxis - adult |
3,009 |
2,995 |
$242K |
| D9110 |
|
3,011 |
2,885 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
3,035 |
3,023 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,677 |
2,669 |
$139K |
| D4341 |
|
1,694 |
480 |
$116K |
| D4910 |
|
1,208 |
1,205 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,297 |
577 |
$87K |
| D9430 |
|
2,638 |
2,529 |
$84K |
| D5520 |
|
1,222 |
267 |
$83K |
| D2331 |
|
930 |
422 |
$77K |
| D5640 |
|
941 |
258 |
$62K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
127 |
115 |
$59K |
| D1120 |
Prophylaxis - child |
1,219 |
1,217 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,902 |
1,895 |
$41K |
| D2160 |
|
506 |
265 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,285 |
3,130 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,895 |
3,724 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,482 |
2,469 |
$33K |
| D2954 |
|
286 |
212 |
$30K |
| D5850 |
|
395 |
358 |
$27K |
| D5851 |
|
357 |
331 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
271 |
162 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,655 |
1,651 |
$20K |
| D5750 |
|
28 |
28 |
$5K |
| D5610 |
|
61 |
46 |
$5K |
| D5211 |
|
12 |
12 |
$4K |
| D5630 |
|
20 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
29 |
$2K |