| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,681 |
766 |
$139K |
| D2740 |
Crown - porcelain/ceramic |
191 |
101 |
$119K |
| D1110 |
Prophylaxis - adult |
2,128 |
2,109 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,733 |
1,708 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,432 |
$80K |
| D2950 |
|
397 |
260 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
570 |
277 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,540 |
1,534 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,205 |
1,196 |
$31K |
| D1120 |
Prophylaxis - child |
677 |
677 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
799 |
778 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,232 |
1,232 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,597 |
1,568 |
$20K |
| D0330 |
Panoramic radiographic image |
386 |
380 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
56 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
94 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,505 |
1,125 |
$10K |
| D3320 |
|
14 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
110 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$2K |
| D0270 |
|
16 |
15 |
$149.15 |