| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
468 |
265 |
$317K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,473 |
573 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,817 |
764 |
$156K |
| D2950 |
|
722 |
418 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,451 |
585 |
$88K |
| D1110 |
Prophylaxis - adult |
1,585 |
1,484 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,176 |
2,095 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,334 |
1,229 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,407 |
1,346 |
$50K |
| D1120 |
Prophylaxis - child |
769 |
741 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
484 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
733 |
690 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
996 |
967 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
298 |
168 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,360 |
1,247 |
$20K |
| D2335 |
|
101 |
47 |
$14K |
| D7311 |
|
116 |
67 |
$14K |
| D4342 |
|
255 |
66 |
$13K |
| D0330 |
Panoramic radiographic image |
256 |
237 |
$12K |
| D9310 |
|
210 |
206 |
$12K |
| D3120 |
|
317 |
186 |
$11K |
| D0272 |
Bitewings - two radiographic images |
304 |
295 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
818 |
426 |
$8K |
| D5211 |
|
12 |
12 |
$6K |
| D4341 |
|
44 |
13 |
$5K |
| D7450 |
|
19 |
17 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
14 |
14 |
$4K |
| D1351 |
Sealant - per tooth |
84 |
25 |
$4K |
| D0270 |
|
65 |
61 |
$828.00 |
| D8660 |
|
20 |
20 |
$438.00 |
| D0350 |
|
120 |
118 |
$0.00 |
| D0340 |
|
23 |
21 |
$0.00 |