| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
417 |
294 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,585 |
876 |
$187K |
| D1110 |
Prophylaxis - adult |
2,907 |
2,874 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
937 |
311 |
$136K |
| D1120 |
Prophylaxis - child |
3,212 |
3,179 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,907 |
3,864 |
$101K |
| D2950 |
|
492 |
340 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,749 |
2,746 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,306 |
1,279 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
955 |
880 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,282 |
1,245 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
202 |
$51K |
| D0330 |
Panoramic radiographic image |
795 |
794 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,367 |
1,352 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,332 |
2,278 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
372 |
252 |
$34K |
| D4341 |
|
211 |
83 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,221 |
1,187 |
$26K |
| D1351 |
Sealant - per tooth |
503 |
114 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,478 |
1,265 |
$13K |
| D0272 |
Bitewings - two radiographic images |
448 |
436 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
41 |
$5K |
| D2394 |
|
20 |
13 |
$3K |
| D4910 |
|
27 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |