| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,844 |
1,619 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,160 |
1,898 |
$218K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,797 |
1,062 |
$206K |
| D1110 |
Prophylaxis - adult |
5,929 |
5,845 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,015 |
5,189 |
$127K |
| D3320 |
|
265 |
242 |
$114K |
| D0274 |
Bitewings - four radiographic images |
5,977 |
5,902 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,025 |
1,058 |
$99K |
| D5110 |
|
165 |
158 |
$94K |
| D2740 |
Crown - porcelain/ceramic |
636 |
458 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
2,939 |
2,884 |
$89K |
| D0330 |
Panoramic radiographic image |
2,817 |
2,115 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
4,748 |
3,912 |
$72K |
| D2950 |
|
601 |
546 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
718 |
522 |
$49K |
| D5214 |
|
175 |
170 |
$48K |
| D5120 |
|
49 |
47 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
3,114 |
3,093 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,945 |
1,922 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
5,285 |
4,196 |
$35K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
43 |
43 |
$33K |
| D1120 |
Prophylaxis - child |
984 |
978 |
$26K |
| D3310 |
|
90 |
55 |
$20K |
| D2331 |
|
700 |
315 |
$20K |
| D4341 |
|
1,542 |
398 |
$13K |
| D5213 |
|
82 |
82 |
$11K |
| D9630 |
|
632 |
521 |
$11K |
| D2954 |
|
113 |
69 |
$9K |
| D1351 |
Sealant - per tooth |
267 |
68 |
$9K |
| D7880 |
|
15 |
15 |
$8K |
| D9310 |
|
113 |
112 |
$7K |
| D8660 |
|
24 |
24 |
$4K |
| D7310 |
|
50 |
33 |
$3K |
| D0272 |
Bitewings - two radiographic images |
147 |
147 |
$3K |
| D3221 |
|
16 |
15 |
$965.14 |
| D0340 |
|
13 |
13 |
$936.26 |
| D0170 |
|
31 |
30 |
$826.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
500 |
306 |
$514.28 |
| D1999 |
|
209 |
198 |
$0.00 |
| D2335 |
|
21 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
145 |
145 |
$0.00 |