| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
409 |
184 |
$315K |
| D1110 |
Prophylaxis - adult |
8,502 |
8,347 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,963 |
2,444 |
$203K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,157 |
1,742 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
9,046 |
8,901 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
6,376 |
5,476 |
$108K |
| D0330 |
Panoramic radiographic image |
2,362 |
2,307 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,783 |
3,721 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,289 |
992 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,000 |
1,953 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,028 |
624 |
$45K |
| D1120 |
Prophylaxis - child |
1,913 |
1,889 |
$38K |
| D2950 |
|
252 |
157 |
$35K |
| D2752 |
|
99 |
52 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,254 |
2,219 |
$34K |
| D1320 |
|
2,186 |
2,162 |
$32K |
| D2331 |
|
718 |
481 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
4,483 |
4,011 |
$19K |
| D1206 |
Topical application of fluoride varnish |
914 |
910 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
267 |
160 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,870 |
1,667 |
$14K |
| D2140 |
|
186 |
101 |
$7K |
| D2160 |
|
111 |
86 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$5K |
| D0272 |
Bitewings - two radiographic images |
521 |
512 |
$5K |
| D2330 |
|
123 |
77 |
$4K |
| D2394 |
|
55 |
51 |
$3K |
| D2332 |
|
69 |
40 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
24 |
$2K |
| D1351 |
Sealant - per tooth |
73 |
13 |
$2K |
| D2335 |
|
19 |
12 |
$1K |
| D0180 |
|
32 |
32 |
$764.15 |
| D2931 |
|
15 |
12 |
$693.06 |
| D1310 |
|
37 |
37 |
$0.00 |