| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
638 |
474 |
$463K |
| D1110 |
Prophylaxis - adult |
3,557 |
3,498 |
$189K |
| D2950 |
|
591 |
464 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,192 |
2,162 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,283 |
3,239 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,473 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
855 |
845 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
307 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,691 |
2,595 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
988 |
972 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,309 |
1,298 |
$38K |
| D4342 |
|
367 |
139 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
247 |
$31K |
| D1120 |
Prophylaxis - child |
587 |
581 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,404 |
1,177 |
$18K |
| D3320 |
|
27 |
25 |
$15K |
| D1351 |
Sealant - per tooth |
206 |
54 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
45 |
$8K |
| D4341 |
|
51 |
19 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
26 |
$6K |
| D0330 |
Panoramic radiographic image |
77 |
75 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
25 |
$3K |
| D2140 |
|
26 |
12 |
$2K |
| D3120 |
|
18 |
13 |
$636.00 |
| D1999 |
|
35 |
29 |
$0.00 |