| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
6,585 |
4,269 |
$274K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,652 |
1,024 |
$240K |
| D2740 |
Crown - porcelain/ceramic |
332 |
185 |
$234K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
332 |
179 |
$188K |
| D0140 |
Limited oral evaluation - problem focused |
4,191 |
3,790 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
7,049 |
5,495 |
$103K |
| D1110 |
Prophylaxis - adult |
1,581 |
1,569 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,153 |
3,711 |
$78K |
| D2335 |
|
452 |
188 |
$62K |
| D7311 |
|
563 |
449 |
$57K |
| D2954 |
|
312 |
199 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
863 |
369 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,011 |
1,003 |
$38K |
| D3320 |
|
46 |
38 |
$21K |
| D2950 |
|
134 |
70 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
140 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
583 |
580 |
$17K |
| D2332 |
|
149 |
90 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
653 |
648 |
$16K |
| D0180 |
|
318 |
310 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
294 |
$12K |
| D1120 |
Prophylaxis - child |
210 |
210 |
$11K |
| D0330 |
Panoramic radiographic image |
129 |
127 |
$8K |
| D3310 |
|
20 |
12 |
$7K |
| D4342 |
|
96 |
34 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
13 |
$2K |
| D0170 |
|
43 |
24 |
$2K |
| D1351 |
Sealant - per tooth |
34 |
13 |
$1K |