| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,118 |
807 |
$789K |
| D1110 |
Prophylaxis - adult |
12,072 |
11,896 |
$639K |
| D0210 |
Intraoral - complete series of radiographic images |
5,429 |
5,344 |
$397K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,565 |
2,243 |
$266K |
| D0274 |
Bitewings - four radiographic images |
7,090 |
7,009 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
9,476 |
9,359 |
$214K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,327 |
1,540 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,171 |
4,084 |
$168K |
| D0140 |
Limited oral evaluation - problem focused |
3,835 |
3,699 |
$144K |
| D2950 |
|
806 |
584 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
7,434 |
6,734 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,770 |
1,076 |
$101K |
| D0180 |
|
2,327 |
2,312 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,129 |
521 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,363 |
2,348 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
377 |
225 |
$51K |
| D1120 |
Prophylaxis - child |
842 |
834 |
$42K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
78 |
53 |
$41K |
| D2394 |
|
142 |
94 |
$14K |
| D3120 |
|
285 |
206 |
$10K |
| D2332 |
|
82 |
58 |
$9K |
| D2335 |
|
63 |
44 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
545 |
407 |
$7K |
| D1351 |
Sealant - per tooth |
105 |
24 |
$4K |
| D2331 |
|
49 |
27 |
$4K |
| D2330 |
|
34 |
14 |
$1K |