| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,391 |
918 |
$662K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,294 |
1,834 |
$506K |
| D9430 |
|
11,629 |
10,344 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
5,725 |
5,710 |
$320K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,511 |
4,498 |
$285K |
| D4341 |
|
3,714 |
1,034 |
$254K |
| D0210 |
Intraoral - complete series of radiographic images |
5,390 |
5,372 |
$250K |
| D4910 |
|
3,199 |
3,183 |
$241K |
| D0330 |
Panoramic radiographic image |
6,134 |
6,110 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,243 |
10,037 |
$166K |
| D1120 |
Prophylaxis - child |
4,062 |
4,048 |
$160K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,978 |
1,369 |
$131K |
| D1110 |
Prophylaxis - adult |
1,166 |
1,163 |
$103K |
| D0274 |
Bitewings - four radiographic images |
4,896 |
4,882 |
$101K |
| D2954 |
|
892 |
628 |
$94K |
| D1351 |
Sealant - per tooth |
3,452 |
835 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,795 |
6,768 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
5,911 |
5,343 |
$70K |
| D0350 |
|
7,487 |
3,633 |
$67K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
126 |
119 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
612 |
388 |
$33K |
| D4342 |
|
558 |
204 |
$23K |
| D2140 |
|
393 |
271 |
$21K |
| D1320 |
|
1,712 |
1,703 |
$20K |
| D2160 |
|
234 |
166 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
120 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
139 |
$14K |
| D9110 |
|
191 |
175 |
$12K |
| D5850 |
|
116 |
116 |
$8K |
| D0272 |
Bitewings - two radiographic images |
471 |
467 |
$6K |
| D3320 |
|
14 |
12 |
$5K |
| D5750 |
|
24 |
24 |
$5K |
| D5410 |
|
102 |
102 |
$4K |
| D5851 |
|
44 |
44 |
$3K |
| D1310 |
|
67 |
67 |
$3K |
| D2331 |
|
14 |
12 |
$1K |
| D1321 |
|
1,522 |
1,512 |
$0.00 |