| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,180 |
2,254 |
$1.74M |
| D7140 |
Extraction, erupted tooth or exposed root |
9,576 |
3,516 |
$903K |
| D0210 |
Intraoral - complete series of radiographic images |
5,989 |
5,922 |
$463K |
| D2950 |
|
3,158 |
2,399 |
$397K |
| D1110 |
Prophylaxis - adult |
7,791 |
7,730 |
$351K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,853 |
8,777 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,646 |
1,747 |
$347K |
| D0140 |
Limited oral evaluation - problem focused |
8,075 |
7,932 |
$278K |
| D0274 |
Bitewings - four radiographic images |
6,978 |
6,927 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
6,691 |
6,648 |
$159K |
| D0220 |
Intraoral - periapical first radiographic image |
10,154 |
9,965 |
$124K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,107 |
660 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
601 |
443 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
577 |
402 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
816 |
481 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,918 |
2,891 |
$67K |
| D2160 |
|
199 |
147 |
$24K |
| D2332 |
|
157 |
106 |
$24K |
| D4341 |
|
103 |
56 |
$23K |
| D2331 |
|
54 |
36 |
$6K |
| D9110 |
|
97 |
97 |
$5K |
| D2140 |
|
59 |
38 |
$5K |
| D1120 |
Prophylaxis - child |
42 |
41 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$154.70 |
| D0270 |
|
12 |
12 |
$150.72 |