| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,230 |
650 |
$436K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,068 |
1,874 |
$288K |
| D1110 |
Prophylaxis - adult |
6,435 |
6,376 |
$239K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,224 |
1,275 |
$169K |
| D2950 |
|
1,427 |
1,090 |
$148K |
| D1206 |
Topical application of fluoride varnish |
7,756 |
7,673 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
6,147 |
6,087 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,918 |
2,886 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,319 |
870 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,024 |
4,288 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,749 |
1,722 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,521 |
1,460 |
$39K |
| D2332 |
|
462 |
248 |
$35K |
| D1120 |
Prophylaxis - child |
1,117 |
1,103 |
$31K |
| D2331 |
|
424 |
274 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
398 |
394 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
168 |
80 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,152 |
1,835 |
$13K |
| D2750 |
|
29 |
12 |
$13K |
| D3320 |
|
36 |
28 |
$13K |
| D3310 |
|
36 |
24 |
$12K |
| D4910 |
|
67 |
66 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
52 |
49 |
$2K |
| D2330 |
|
35 |
26 |
$2K |
| D0603 |
|
597 |
586 |
$250.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$189.09 |
| D0602 |
|
25 |
25 |
$55.00 |