| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
272 |
200 |
$215K |
| D1110 |
Prophylaxis - adult |
3,664 |
3,595 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,172 |
924 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,544 |
4,451 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,139 |
1,106 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
985 |
605 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
507 |
296 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,844 |
1,815 |
$45K |
| D2140 |
|
864 |
527 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
378 |
236 |
$33K |
| D1120 |
Prophylaxis - child |
1,304 |
1,286 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,480 |
1,457 |
$23K |
| D2160 |
|
358 |
250 |
$23K |
| D2331 |
|
280 |
199 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
192 |
122 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
875 |
865 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
842 |
817 |
$21K |
| D1206 |
Topical application of fluoride varnish |
424 |
413 |
$11K |
| D2330 |
|
139 |
87 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,033 |
999 |
$7K |
| D0330 |
Panoramic radiographic image |
92 |
84 |
$6K |
| D0350 |
|
128 |
127 |
$3K |
| D2335 |
|
32 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
101 |
99 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
103 |
$1K |
| D2332 |
|
15 |
12 |
$1K |
| D1320 |
|
48 |
46 |
$630.00 |
| D0270 |
|
14 |
13 |
$71.50 |