| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
681 |
331 |
$468K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,557 |
776 |
$215K |
| D1110 |
Prophylaxis - adult |
2,625 |
2,518 |
$147K |
| D0274 |
Bitewings - four radiographic images |
2,226 |
2,155 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,203 |
3,117 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,897 |
1,816 |
$74K |
| D1120 |
Prophylaxis - child |
1,440 |
1,412 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,054 |
2,008 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
559 |
267 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
704 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
233 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
378 |
359 |
$27K |
| D0330 |
Panoramic radiographic image |
380 |
364 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,443 |
1,389 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
86 |
$14K |
| D2954 |
|
33 |
25 |
$6K |
| D0272 |
Bitewings - two radiographic images |
131 |
128 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
157 |
$2K |