| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,566 |
912 |
$1.10M |
| D1110 |
Prophylaxis - adult |
10,701 |
10,546 |
$572K |
| D0120 |
Periodic oral evaluation - established patient |
10,574 |
10,434 |
$246K |
| D2950 |
|
1,351 |
905 |
$216K |
| D0274 |
Bitewings - four radiographic images |
4,357 |
4,308 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
973 |
$115K |
| D1206 |
Topical application of fluoride varnish |
3,385 |
3,347 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
2,276 |
2,222 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,285 |
1,245 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,774 |
1,736 |
$77K |
| D0330 |
Panoramic radiographic image |
1,295 |
1,260 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
504 |
221 |
$68K |
| D1120 |
Prophylaxis - child |
1,283 |
1,269 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
676 |
470 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,446 |
2,346 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
36 |
$23K |
| D0180 |
|
324 |
319 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
69 |
$12K |
| D4342 |
|
155 |
69 |
$12K |
| D4341 |
|
76 |
30 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$7K |
| D1351 |
Sealant - per tooth |
185 |
54 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
253 |
250 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
41 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
29 |
$3K |
| D2332 |
|
16 |
12 |
$2K |
| D9110 |
|
41 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
78 |
$1K |
| D0272 |
Bitewings - two radiographic images |
43 |
42 |
$1K |
| D2140 |
|
18 |
12 |
$1K |