| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
689 |
498 |
$837K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,860 |
1,204 |
$437K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,359 |
873 |
$250K |
| D4341 |
|
769 |
273 |
$207K |
| D1110 |
Prophylaxis - adult |
1,484 |
1,465 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
1,053 |
1,011 |
$142K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
452 |
218 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,536 |
1,485 |
$128K |
| D1206 |
Topical application of fluoride varnish |
2,728 |
2,641 |
$117K |
| D4910 |
|
681 |
675 |
$103K |
| D7140 |
Extraction, erupted tooth or exposed root |
550 |
290 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
1,153 |
1,096 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
203 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
883 |
879 |
$63K |
| D2950 |
|
226 |
182 |
$60K |
| D4355 |
|
317 |
315 |
$57K |
| D0274 |
Bitewings - four radiographic images |
826 |
819 |
$56K |
| D1330 |
|
1,496 |
1,462 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,007 |
921 |
$28K |
| D1351 |
Sealant - per tooth |
311 |
67 |
$20K |
| D4921 |
|
315 |
110 |
$19K |
| D1120 |
Prophylaxis - child |
257 |
255 |
$19K |
| D9310 |
|
252 |
242 |
$16K |
| D0270 |
|
474 |
454 |
$10K |
| D4342 |
|
33 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
76 |
76 |
$3K |
| D9210 |
|
27 |
24 |
$1K |