| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,514 |
1,400 |
$446K |
| D2740 |
Crown - porcelain/ceramic |
432 |
305 |
$301K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
390 |
190 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
4,976 |
4,551 |
$174K |
| D1110 |
Prophylaxis - adult |
3,419 |
3,351 |
$168K |
| D7320 |
|
744 |
309 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,149 |
3,089 |
$92K |
| D0330 |
Panoramic radiographic image |
2,233 |
2,184 |
$89K |
| D9450 |
|
4,209 |
3,714 |
$88K |
| D7310 |
|
698 |
543 |
$84K |
| D9110 |
|
1,946 |
1,821 |
$71K |
| D2950 |
|
456 |
282 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,574 |
5,141 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,767 |
2,714 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,204 |
3,405 |
$57K |
| D7230 |
|
214 |
154 |
$33K |
| D2954 |
|
215 |
111 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
833 |
819 |
$30K |
| D2394 |
|
292 |
187 |
$30K |
| D7240 |
Removal of impacted tooth - completely bony |
145 |
83 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
290 |
274 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
97 |
$12K |
| D7911 |
|
293 |
185 |
$10K |
| D1206 |
Topical application of fluoride varnish |
710 |
688 |
$10K |
| D3120 |
|
274 |
144 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
101 |
$9K |
| D7311 |
|
85 |
65 |
$9K |
| D1354 |
|
635 |
85 |
$9K |
| D5211 |
|
17 |
17 |
$8K |
| D2335 |
|
54 |
26 |
$7K |
| D0270 |
|
506 |
491 |
$6K |
| D5212 |
|
12 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
242 |
238 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D0190 |
|
1,145 |
1,125 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$660.00 |
| D0273 |
|
17 |
16 |
$401.00 |
| D4211 |
|
22 |
16 |
$398.00 |
| D9951 |
|
19 |
18 |
$0.00 |
| D1330 |
|
121 |
115 |
$0.00 |