| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
709 |
514 |
$336K |
| D1110 |
Prophylaxis - adult |
2,352 |
2,338 |
$203K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,385 |
2,375 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
2,250 |
2,239 |
$131K |
| D2140 |
|
2,383 |
1,028 |
$128K |
| D4341 |
|
1,600 |
429 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
2,096 |
2,086 |
$96K |
| D3320 |
|
256 |
210 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
796 |
465 |
$92K |
| D9430 |
|
2,906 |
2,362 |
$92K |
| D2954 |
|
656 |
492 |
$69K |
| D1120 |
Prophylaxis - child |
1,542 |
1,536 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
963 |
482 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,910 |
3,886 |
$51K |
| D0350 |
|
5,271 |
2,064 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,069 |
2,054 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
529 |
308 |
$35K |
| D4910 |
|
316 |
316 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,079 |
3,102 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
845 |
822 |
$10K |
| D1351 |
Sealant - per tooth |
61 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$960.00 |
| D1999 |
|
14 |
14 |
$0.00 |