| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,075 |
569 |
$731K |
| D1110 |
Prophylaxis - adult |
5,935 |
5,827 |
$319K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,554 |
1,476 |
$218K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,519 |
757 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
7,106 |
6,980 |
$172K |
| D1120 |
Prophylaxis - child |
2,442 |
2,410 |
$122K |
| D0274 |
Bitewings - four radiographic images |
3,541 |
3,467 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,251 |
845 |
$90K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
160 |
94 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,972 |
2,928 |
$86K |
| D0330 |
Panoramic radiographic image |
1,546 |
1,503 |
$86K |
| D9110 |
|
1,706 |
1,616 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
998 |
972 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,431 |
2,314 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
151 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
70 |
$14K |
| D0272 |
Bitewings - two radiographic images |
299 |
298 |
$8K |
| D2950 |
|
30 |
27 |
$4K |
| D2331 |
|
33 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
352 |
213 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
28 |
13 |
$1K |
| D1999 |
|
369 |
341 |
$0.00 |