| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
898 |
613 |
$427K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,727 |
1,501 |
$323K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,520 |
4,506 |
$298K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,980 |
2,280 |
$266K |
| D4341 |
|
2,949 |
827 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
2,386 |
2,377 |
$195K |
| D4910 |
|
2,513 |
2,498 |
$191K |
| D1110 |
Prophylaxis - adult |
2,036 |
2,025 |
$173K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,958 |
1,293 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
2,546 |
2,534 |
$121K |
| D9430 |
|
3,742 |
3,645 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,833 |
1,052 |
$99K |
| D1120 |
Prophylaxis - child |
1,910 |
1,904 |
$88K |
| D0330 |
Panoramic radiographic image |
2,579 |
2,576 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,297 |
4,279 |
$63K |
| D0350 |
|
6,514 |
1,583 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,661 |
6,702 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,393 |
2,384 |
$46K |
| D7240 |
Removal of impacted tooth - completely bony |
158 |
76 |
$36K |
| D7230 |
|
99 |
60 |
$19K |
| D2330 |
|
147 |
96 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
764 |
$9K |
| D1351 |
Sealant - per tooth |
300 |
81 |
$9K |
| D4342 |
|
160 |
53 |
$7K |
| D0270 |
|
1,242 |
1,238 |
$6K |
| D1206 |
Topical application of fluoride varnish |
387 |
387 |
$5K |
| D2394 |
|
46 |
39 |
$4K |
| D0272 |
Bitewings - two radiographic images |
104 |
104 |
$1K |
| D1999 |
|
14 |
14 |
$0.00 |