| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,224 |
757 |
$866K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,663 |
1,395 |
$321K |
| D2950 |
|
994 |
683 |
$178K |
| D1351 |
Sealant - per tooth |
4,964 |
675 |
$154K |
| D0210 |
Intraoral - complete series of radiographic images |
1,930 |
1,866 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
2,344 |
2,244 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,623 |
2,612 |
$112K |
| D1110 |
Prophylaxis - adult |
2,242 |
2,233 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
668 |
450 |
$104K |
| D1120 |
Prophylaxis - child |
2,432 |
2,422 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
882 |
558 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,760 |
$71K |
| D1206 |
Topical application of fluoride varnish |
3,498 |
3,481 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
3,712 |
3,560 |
$60K |
| D4341 |
|
371 |
141 |
$59K |
| D4342 |
|
473 |
161 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
281 |
136 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,290 |
1,283 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,530 |
2,181 |
$33K |
| D4910 |
|
216 |
215 |
$20K |
| D3320 |
|
13 |
13 |
$7K |
| D0272 |
Bitewings - two radiographic images |
232 |
232 |
$6K |
| D0240 |
|
237 |
120 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
22 |
12 |
$5K |
| D2954 |
|
16 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
17 |
$2K |
| D2332 |
|
15 |
12 |
$2K |
| D9310 |
|
34 |
34 |
$2K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$1K |