| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
680 |
461 |
$547K |
| D2394 |
|
4,463 |
2,286 |
$356K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,762 |
2,461 |
$329K |
| D1110 |
Prophylaxis - adult |
7,266 |
7,000 |
$276K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,993 |
1,532 |
$189K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
1,620 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,339 |
5,107 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
7,222 |
7,022 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
5,273 |
4,462 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,919 |
7,549 |
$130K |
| D0330 |
Panoramic radiographic image |
2,401 |
2,297 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,248 |
5,087 |
$90K |
| D0274 |
Bitewings - four radiographic images |
3,995 |
3,842 |
$89K |
| D1120 |
Prophylaxis - child |
3,526 |
3,417 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
10,176 |
9,320 |
$59K |
| D2335 |
|
638 |
337 |
$59K |
| D1351 |
Sealant - per tooth |
2,256 |
710 |
$57K |
| D2954 |
|
243 |
190 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
998 |
608 |
$51K |
| D2950 |
|
344 |
254 |
$49K |
| D1320 |
|
1,962 |
1,898 |
$35K |
| D2332 |
|
488 |
318 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,106 |
2,042 |
$24K |
| D2161 |
|
254 |
128 |
$19K |
| D2160 |
|
290 |
138 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
27 |
$16K |
| D4910 |
|
279 |
270 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
155 |
$14K |
| D3320 |
|
13 |
12 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
129 |
77 |
$7K |
| D0180 |
|
268 |
260 |
$7K |
| D4341 |
|
39 |
13 |
$3K |
| D2140 |
|
22 |
15 |
$880.00 |