| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
946 |
261 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
690 |
482 |
$48K |
| D1110 |
Prophylaxis - adult |
1,401 |
1,390 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,813 |
1,750 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,774 |
1,748 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
998 |
973 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
99 |
61 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
177 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,537 |
1,525 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
998 |
974 |
$18K |
| D0330 |
Panoramic radiographic image |
277 |
270 |
$13K |
| D5110 |
|
12 |
12 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,123 |
1,104 |
$8K |
| D9994 |
|
1,011 |
993 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
53 |
$4K |
| D1206 |
Topical application of fluoride varnish |
206 |
202 |
$4K |
| D2950 |
|
20 |
13 |
$2K |
| D2954 |
|
30 |
24 |
$2K |
| D4346 |
|
29 |
27 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
40 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
319 |
271 |
$1K |
| D9992 |
|
13 |
13 |
$0.00 |
| D4910 |
|
13 |
13 |
$0.00 |