| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
914 |
713 |
$454K |
| D0210 |
Intraoral - complete series of radiographic images |
3,509 |
3,475 |
$132K |
| D1110 |
Prophylaxis - adult |
3,706 |
3,669 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,358 |
782 |
$94K |
| D2954 |
|
880 |
668 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,159 |
3,137 |
$79K |
| D2160 |
|
1,124 |
649 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,551 |
2,523 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,918 |
3,772 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,082 |
1,076 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,181 |
4,010 |
$20K |
| D0274 |
Bitewings - four radiographic images |
908 |
899 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
244 |
166 |
$12K |
| D2161 |
|
165 |
128 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
93 |
$10K |
| D5213 |
|
12 |
12 |
$7K |
| D2335 |
|
76 |
39 |
$5K |
| D1120 |
Prophylaxis - child |
137 |
136 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
63 |
$787.50 |
| D2140 |
|
17 |
13 |
$738.75 |
| D9920 |
|
39 |
38 |
$697.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$656.25 |
| D3221 |
|
14 |
13 |
$520.00 |
| D9110 |
|
25 |
25 |
$282.50 |