| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
964 |
474 |
$580K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,637 |
2,916 |
$544K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,000 |
2,540 |
$356K |
| D1110 |
Prophylaxis - adult |
5,735 |
5,707 |
$280K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,253 |
2,039 |
$249K |
| D1120 |
Prophylaxis - child |
4,587 |
4,581 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
6,817 |
6,801 |
$181K |
| D0330 |
Panoramic radiographic image |
2,881 |
2,858 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,599 |
3,570 |
$145K |
| D0274 |
Bitewings - four radiographic images |
4,894 |
4,865 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,842 |
5,831 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
965 |
759 |
$132K |
| D2950 |
|
767 |
538 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
2,807 |
2,703 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,414 |
1,392 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,183 |
3,042 |
$48K |
| D2791 |
|
71 |
57 |
$47K |
| D0272 |
Bitewings - two radiographic images |
916 |
915 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,134 |
1,298 |
$18K |
| D7250 |
|
75 |
42 |
$15K |
| D2330 |
|
153 |
101 |
$12K |
| D2331 |
|
107 |
77 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
48 |
$9K |
| D1206 |
Topical application of fluoride varnish |
228 |
228 |
$7K |
| D4355 |
|
37 |
37 |
$4K |
| D2332 |
|
16 |
12 |
$2K |
| D2335 |
|
12 |
12 |
$2K |