| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
943 |
724 |
$635K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,579 |
2,788 |
$554K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,846 |
2,257 |
$383K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,726 |
1,948 |
$350K |
| D1110 |
Prophylaxis - adult |
5,989 |
5,966 |
$241K |
| D0210 |
Intraoral - complete series of radiographic images |
4,262 |
4,155 |
$220K |
| D2950 |
|
1,207 |
930 |
$206K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,700 |
1,099 |
$189K |
| D5110 |
|
343 |
336 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,314 |
5,280 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,644 |
5,628 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
4,164 |
4,118 |
$122K |
| D4341 |
|
746 |
301 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,232 |
810 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
8,438 |
8,290 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,421 |
3,410 |
$92K |
| D4342 |
|
881 |
311 |
$82K |
| D5120 |
|
94 |
92 |
$60K |
| D1120 |
Prophylaxis - child |
1,168 |
1,168 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,407 |
4,984 |
$48K |
| D4910 |
|
520 |
520 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,778 |
1,778 |
$42K |
| D7310 |
|
439 |
199 |
$41K |
| D4346 |
|
570 |
570 |
$38K |
| D2792 |
|
50 |
42 |
$30K |
| D0330 |
Panoramic radiographic image |
372 |
371 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$7K |
| D2331 |
|
67 |
27 |
$4K |
| D2332 |
|
20 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
97 |
97 |
$2K |
| D7220 |
|
38 |
26 |
$2K |
| D1354 |
|
73 |
37 |
$2K |
| D4355 |
|
12 |
12 |
$302.82 |
| D9986 |
|
15 |
15 |
$0.00 |