| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
474 |
274 |
$317K |
| D1110 |
Prophylaxis - adult |
3,659 |
3,448 |
$179K |
| D0274 |
Bitewings - four radiographic images |
3,252 |
3,058 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,651 |
4,441 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
796 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,155 |
580 |
$85K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
160 |
92 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
2,111 |
1,952 |
$76K |
| D1120 |
Prophylaxis - child |
1,579 |
1,541 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,099 |
1,060 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,726 |
1,636 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
469 |
197 |
$63K |
| D2950 |
|
416 |
241 |
$63K |
| D4342 |
|
741 |
260 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,993 |
1,915 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,575 |
2,318 |
$36K |
| D1351 |
Sealant - per tooth |
652 |
150 |
$25K |
| D7311 |
|
186 |
139 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
55 |
$10K |
| D5212 |
|
13 |
13 |
$8K |
| D0272 |
Bitewings - two radiographic images |
232 |
223 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
404 |
$6K |
| D2330 |
|
59 |
19 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
24 |
$3K |