| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
944 |
689 |
$449K |
| D1110 |
Prophylaxis - adult |
2,758 |
2,735 |
$229K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,751 |
1,067 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,704 |
2,689 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,284 |
7,173 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,295 |
2,271 |
$122K |
| D0274 |
Bitewings - four radiographic images |
4,371 |
4,320 |
$91K |
| D2954 |
|
447 |
384 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
697 |
385 |
$37K |
| D0330 |
Panoramic radiographic image |
1,208 |
1,198 |
$35K |
| D4341 |
|
450 |
126 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
210 |
$29K |
| D9430 |
|
949 |
924 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
218 |
$20K |
| D1120 |
Prophylaxis - child |
344 |
335 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
199 |
198 |
$8K |
| D2140 |
|
105 |
50 |
$6K |
| D2330 |
|
48 |
28 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
15 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
139 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
99 |
$1K |
| D0272 |
Bitewings - two radiographic images |
83 |
79 |
$850.00 |
| D9110 |
|
15 |
14 |
$819.00 |