| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
4,659 |
1,416 |
$3.29M |
| D1110 |
Prophylaxis - adult |
11,805 |
11,322 |
$599K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,636 |
3,218 |
$351K |
| D0274 |
Bitewings - four radiographic images |
9,382 |
9,024 |
$324K |
| D0120 |
Periodic oral evaluation - established patient |
10,876 |
10,441 |
$250K |
| D0220 |
Intraoral - periapical first radiographic image |
15,904 |
15,078 |
$246K |
| D1120 |
Prophylaxis - child |
4,591 |
4,469 |
$219K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,141 |
12,832 |
$201K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
365 |
193 |
$199K |
| D2950 |
|
1,022 |
535 |
$162K |
| D0140 |
Limited oral evaluation - problem focused |
4,377 |
4,131 |
$161K |
| D1206 |
Topical application of fluoride varnish |
6,160 |
5,961 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,340 |
1,567 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
1,914 |
1,864 |
$132K |
| D0180 |
|
3,015 |
2,906 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,457 |
2,378 |
$91K |
| D0272 |
Bitewings - two radiographic images |
1,677 |
1,652 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
586 |
439 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
424 |
225 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
204 |
110 |
$27K |
| D0330 |
Panoramic radiographic image |
602 |
588 |
$26K |
| D2331 |
|
356 |
217 |
$25K |
| D1351 |
Sealant - per tooth |
276 |
80 |
$10K |
| D2330 |
|
141 |
79 |
$9K |
| D9110 |
|
164 |
149 |
$7K |
| D0270 |
|
375 |
362 |
$5K |
| D2954 |
|
19 |
13 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
24 |
$3K |
| D1354 |
|
100 |
24 |
$1K |
| D1999 |
|
386 |
346 |
$0.00 |