| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,161 |
2,329 |
$315K |
| D0140 |
Limited oral evaluation - problem focused |
9,198 |
8,292 |
$214K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,889 |
1,197 |
$130K |
| D4355 |
|
2,020 |
2,009 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,135 |
760 |
$93K |
| D2740 |
Crown - porcelain/ceramic |
191 |
127 |
$90K |
| D1110 |
Prophylaxis - adult |
2,508 |
2,473 |
$88K |
| D2394 |
|
831 |
576 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
7,832 |
7,190 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,257 |
2,217 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,419 |
1,310 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,811 |
2,776 |
$58K |
| D2335 |
|
544 |
289 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,946 |
4,845 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,287 |
2,261 |
$47K |
| D7310 |
|
476 |
341 |
$47K |
| D2950 |
|
326 |
230 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
865 |
549 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
92 |
82 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
723 |
309 |
$36K |
| D0330 |
Panoramic radiographic image |
1,341 |
1,327 |
$31K |
| D1120 |
Prophylaxis - child |
642 |
628 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,011 |
990 |
$25K |
| D2332 |
|
277 |
185 |
$19K |
| D3320 |
|
49 |
41 |
$18K |
| D2331 |
|
14 |
12 |
$745.93 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$299.00 |