| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
835 |
527 |
$480K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,946 |
578 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,296 |
829 |
$145K |
| D1110 |
Prophylaxis - adult |
1,970 |
1,966 |
$95K |
| D2950 |
|
565 |
441 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,674 |
1,581 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,020 |
2,018 |
$81K |
| D9243 |
|
1,042 |
287 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
461 |
344 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,071 |
2,068 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,261 |
3,031 |
$50K |
| D1120 |
Prophylaxis - child |
1,237 |
1,237 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
920 |
914 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
269 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,092 |
1,090 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,467 |
2,179 |
$29K |
| D9239 |
|
324 |
286 |
$27K |
| D1206 |
Topical application of fluoride varnish |
904 |
902 |
$25K |
| D0330 |
Panoramic radiographic image |
492 |
491 |
$21K |
| D1351 |
Sealant - per tooth |
612 |
80 |
$17K |
| D7261 |
|
58 |
52 |
$17K |
| D1352 |
|
224 |
57 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
671 |
671 |
$14K |
| D4346 |
|
207 |
207 |
$13K |
| D4910 |
|
53 |
53 |
$4K |
| D0272 |
Bitewings - two radiographic images |
76 |
76 |
$1K |