| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,642 |
2,844 |
$538K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,311 |
7,282 |
$464K |
| D0210 |
Intraoral - complete series of radiographic images |
6,886 |
6,871 |
$319K |
| D2740 |
Crown - porcelain/ceramic |
322 |
254 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,804 |
1,002 |
$119K |
| D4341 |
|
1,086 |
312 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,166 |
1,164 |
$66K |
| D9430 |
|
1,562 |
1,538 |
$50K |
| D3221 |
|
734 |
628 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,127 |
2,196 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
77 |
75 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,283 |
1,279 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
263 |
$25K |
| D2954 |
|
230 |
191 |
$24K |
| D1110 |
Prophylaxis - adult |
241 |
240 |
$21K |
| D4910 |
|
200 |
200 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,251 |
1,238 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
112 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
119 |
$12K |
| D1120 |
Prophylaxis - child |
130 |
130 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
335 |
$4K |
| D4342 |
|
34 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$330.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$288.00 |