| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,372 |
1,606 |
$1.66M |
| D1110 |
Prophylaxis - adult |
9,220 |
9,091 |
$484K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,967 |
1,437 |
$415K |
| D2950 |
|
1,843 |
1,198 |
$290K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
496 |
345 |
$260K |
| D0210 |
Intraoral - complete series of radiographic images |
2,724 |
2,674 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,095 |
3,047 |
$122K |
| D0274 |
Bitewings - four radiographic images |
2,965 |
2,923 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
4,202 |
4,130 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,298 |
486 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,724 |
5,582 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,092 |
2,037 |
$81K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
110 |
107 |
$69K |
| D3320 |
|
117 |
103 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
801 |
577 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,922 |
3,611 |
$54K |
| D0330 |
Panoramic radiographic image |
967 |
952 |
$51K |
| D1120 |
Prophylaxis - child |
569 |
558 |
$28K |
| D3310 |
|
64 |
39 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
242 |
$20K |
| D1206 |
Topical application of fluoride varnish |
492 |
484 |
$13K |
| D5211 |
|
25 |
24 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
56 |
$6K |
| D5212 |
|
12 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
57 |
$5K |
| D2331 |
|
36 |
26 |
$3K |
| D2140 |
|
18 |
12 |
$1K |
| D2330 |
|
15 |
12 |
$1K |