| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
383 |
174 |
$264K |
| D1352 |
|
2,932 |
405 |
$203K |
| D2950 |
|
665 |
373 |
$114K |
| D1110 |
Prophylaxis - adult |
2,658 |
2,649 |
$113K |
| D4341 |
|
688 |
194 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,065 |
435 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,645 |
3,639 |
$90K |
| D4355 |
|
1,095 |
1,080 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
764 |
478 |
$82K |
| D1120 |
Prophylaxis - child |
1,602 |
1,602 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,105 |
2,064 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,665 |
1,655 |
$58K |
| D0330 |
Panoramic radiographic image |
953 |
950 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,988 |
1,988 |
$48K |
| D3320 |
|
81 |
67 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,498 |
1,496 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
353 |
257 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,835 |
2,705 |
$40K |
| D4910 |
|
386 |
385 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
524 |
$27K |
| D2335 |
|
165 |
95 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
113 |
$22K |
| D1351 |
Sealant - per tooth |
723 |
171 |
$22K |
| D2332 |
|
227 |
122 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
133 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,416 |
2,112 |
$17K |
| D0180 |
|
269 |
269 |
$9K |
| D2940 |
|
146 |
91 |
$9K |
| D7310 |
|
31 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$1K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$750.00 |
| D0270 |
|
16 |
16 |
$167.75 |