| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
715 |
437 |
$496K |
| D1110 |
Prophylaxis - adult |
6,106 |
5,999 |
$314K |
| D0274 |
Bitewings - four radiographic images |
4,833 |
4,740 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
6,039 |
5,942 |
$140K |
| D0330 |
Panoramic radiographic image |
2,051 |
2,016 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
3,368 |
3,154 |
$129K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
232 |
134 |
$123K |
| D2950 |
|
774 |
510 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
862 |
500 |
$119K |
| D1120 |
Prophylaxis - child |
1,536 |
1,517 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,404 |
2,381 |
$70K |
| D4341 |
|
533 |
206 |
$61K |
| D4342 |
|
692 |
250 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,298 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
541 |
366 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
568 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,162 |
2,062 |
$32K |
| D7311 |
|
200 |
167 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
397 |
230 |
$23K |
| D1351 |
Sealant - per tooth |
442 |
109 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
781 |
449 |
$9K |
| D0180 |
|
203 |
201 |
$8K |
| D3120 |
|
162 |
117 |
$6K |
| D2954 |
|
31 |
20 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$3K |
| D2331 |
|
21 |
16 |
$2K |
| D1330 |
|
40 |
38 |
$546.00 |
| D9110 |
|
12 |
12 |
$460.00 |