| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,764 |
676 |
$1.22M |
| D1110 |
Prophylaxis - adult |
4,656 |
4,538 |
$236K |
| D2950 |
|
1,156 |
538 |
$184K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
327 |
136 |
$168K |
| D0274 |
Bitewings - four radiographic images |
3,303 |
3,203 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,432 |
801 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
5,607 |
5,313 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,360 |
4,289 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
837 |
815 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,646 |
2,581 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,008 |
532 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,192 |
1,138 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
491 |
326 |
$37K |
| D1120 |
Prophylaxis - child |
752 |
739 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,287 |
1,259 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
969 |
911 |
$32K |
| D0180 |
|
851 |
828 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
207 |
80 |
$25K |
| D2331 |
|
122 |
62 |
$8K |
| D0272 |
Bitewings - two radiographic images |
118 |
117 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
28 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
92 |
$2K |
| D2330 |
|
23 |
12 |
$1K |
| D0270 |
|
95 |
89 |
$1K |
| D4211 |
|
39 |
33 |
$133.00 |
| D1999 |
|
252 |
204 |
$0.00 |