| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,367 |
1,880 |
$2.43M |
| D1110 |
Prophylaxis - adult |
17,409 |
16,946 |
$921K |
| D9450 |
|
18,398 |
15,585 |
$475K |
| D0120 |
Periodic oral evaluation - established patient |
19,754 |
19,265 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,492 |
3,863 |
$442K |
| D2950 |
|
2,205 |
1,513 |
$352K |
| D0274 |
Bitewings - four radiographic images |
8,498 |
8,288 |
$305K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,979 |
1,892 |
$286K |
| D1120 |
Prophylaxis - child |
5,346 |
5,217 |
$264K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
465 |
273 |
$261K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,891 |
2,707 |
$256K |
| D0210 |
Intraoral - complete series of radiographic images |
3,086 |
2,981 |
$214K |
| D1206 |
Topical application of fluoride varnish |
8,071 |
7,889 |
$207K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
233 |
226 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,478 |
3,369 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
2,543 |
2,478 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,070 |
897 |
$95K |
| D9110 |
|
2,346 |
2,246 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,916 |
5,671 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
402 |
250 |
$58K |
| D3320 |
|
108 |
96 |
$56K |
| D9920 |
|
525 |
500 |
$41K |
| D2332 |
|
346 |
267 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,220 |
1,188 |
$35K |
| D2330 |
|
427 |
267 |
$30K |
| D2331 |
|
280 |
203 |
$22K |
| D2335 |
|
102 |
82 |
$14K |
| D3310 |
|
22 |
14 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
594 |
509 |
$7K |
| D2954 |
|
15 |
12 |
$2K |
| D3120 |
|
15 |
13 |
$552.00 |
| D0364 |
|
12 |
12 |
$0.00 |