| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
963 |
695 |
$623K |
| D1110 |
Prophylaxis - adult |
8,117 |
7,913 |
$430K |
| D0274 |
Bitewings - four radiographic images |
6,290 |
6,130 |
$224K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,589 |
1,755 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
8,272 |
8,097 |
$197K |
| D0220 |
Intraoral - periapical first radiographic image |
10,698 |
10,306 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,468 |
3,384 |
$154K |
| D1120 |
Prophylaxis - child |
3,027 |
3,000 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,224 |
4,171 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,606 |
8,157 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,860 |
1,192 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
1,567 |
1,531 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
2,753 |
2,643 |
$108K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
99 |
72 |
$52K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
51 |
$36K |
| D2954 |
|
173 |
134 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
129 |
$22K |
| D0272 |
Bitewings - two radiographic images |
685 |
679 |
$20K |
| D1351 |
Sealant - per tooth |
313 |
92 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
49 |
$6K |
| D0330 |
Panoramic radiographic image |
147 |
146 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
26 |
$4K |
| D2330 |
|
19 |
12 |
$1K |