| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
668 |
234 |
$74K |
| D2740 |
Crown - porcelain/ceramic |
78 |
44 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,308 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,164 |
1,546 |
$31K |
| D5110 |
|
45 |
40 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
264 |
121 |
$29K |
| D1110 |
Prophylaxis - adult |
666 |
655 |
$29K |
| D0330 |
Panoramic radiographic image |
569 |
468 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,003 |
1,817 |
$19K |
| D0274 |
Bitewings - four radiographic images |
611 |
604 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
564 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
546 |
487 |
$13K |
| D2950 |
|
116 |
84 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$8K |
| D5120 |
|
12 |
12 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
45 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
16 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
55 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
52 |
52 |
$542.04 |