| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
754 |
382 |
$427K |
| D8670 |
Periodic orthodontic treatment visit |
671 |
639 |
$169K |
| D1110 |
Prophylaxis - adult |
3,055 |
2,765 |
$151K |
| D0274 |
Bitewings - four radiographic images |
1,933 |
1,790 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,721 |
2,496 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,072 |
3,204 |
$54K |
| D2950 |
|
352 |
218 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,247 |
1,067 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
247 |
101 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,180 |
1,952 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
347 |
329 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
252 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
40 |
$7K |
| D5212 |
|
16 |
14 |
$7K |
| D1206 |
Topical application of fluoride varnish |
206 |
198 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
38 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
31 |
$5K |
| D0330 |
Panoramic radiographic image |
109 |
85 |
$4K |
| D4342 |
|
50 |
17 |
$4K |
| D1120 |
Prophylaxis - child |
55 |
54 |
$3K |
| D8680 |
|
17 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
89 |
56 |
$2K |
| D9110 |
|
12 |
12 |
$820.00 |
| D0270 |
|
19 |
12 |
$132.00 |