| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
825 |
426 |
$576K |
| D1110 |
Prophylaxis - adult |
1,319 |
1,256 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
338 |
97 |
$49K |
| D9450 |
|
3,048 |
2,323 |
$48K |
| D2954 |
|
244 |
130 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
605 |
543 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,446 |
1,408 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
866 |
771 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
614 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,823 |
1,617 |
$27K |
| D0274 |
Bitewings - four radiographic images |
566 |
551 |
$20K |
| D3120 |
|
521 |
259 |
$18K |
| D2950 |
|
94 |
69 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,149 |
899 |
$14K |
| D1120 |
Prophylaxis - child |
264 |
257 |
$14K |
| D0330 |
Panoramic radiographic image |
186 |
167 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
81 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
196 |
190 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$3K |
| D1206 |
Topical application of fluoride varnish |
40 |
38 |
$1K |