| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,938 |
1,513 |
$701K |
| D7140 |
Extraction, erupted tooth or exposed root |
14,015 |
4,406 |
$681K |
| D1110 |
Prophylaxis - adult |
12,384 |
12,228 |
$444K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,703 |
1,457 |
$234K |
| D0274 |
Bitewings - four radiographic images |
9,371 |
9,259 |
$198K |
| D0140 |
Limited oral evaluation - problem focused |
8,192 |
8,031 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
10,563 |
10,416 |
$181K |
| D0330 |
Panoramic radiographic image |
5,837 |
5,775 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
14,273 |
13,584 |
$122K |
| D1206 |
Topical application of fluoride varnish |
8,187 |
8,088 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,900 |
4,838 |
$105K |
| D5110 |
|
192 |
190 |
$99K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
262 |
183 |
$90K |
| D2950 |
|
838 |
738 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,533 |
1,522 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
833 |
605 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,390 |
3,661 |
$33K |
| D5120 |
|
61 |
61 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
43 |
40 |
$17K |
| D4910 |
|
256 |
255 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
186 |
$14K |
| D5214 |
|
24 |
24 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,064 |
1,042 |
$13K |
| D4341 |
|
107 |
40 |
$9K |
| D2160 |
|
93 |
67 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
79 |
$6K |
| D3310 |
|
20 |
13 |
$5K |
| D1120 |
Prophylaxis - child |
371 |
365 |
$4K |
| D2140 |
|
87 |
69 |
$3K |
| D2332 |
|
38 |
26 |
$3K |
| D2954 |
|
23 |
12 |
$2K |
| D2331 |
|
13 |
12 |
$811.12 |
| D0272 |
Bitewings - two radiographic images |
47 |
46 |
$82.50 |