| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
705 |
434 |
$333K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,009 |
927 |
$235K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,641 |
2,627 |
$173K |
| D0210 |
Intraoral - complete series of radiographic images |
2,626 |
2,612 |
$125K |
| D1110 |
Prophylaxis - adult |
872 |
867 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,116 |
478 |
$74K |
| D9430 |
|
2,035 |
1,856 |
$65K |
| D4341 |
|
698 |
178 |
$49K |
| D0330 |
Panoramic radiographic image |
1,448 |
1,448 |
$43K |
| D0350 |
|
3,248 |
825 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
336 |
336 |
$28K |
| D4910 |
|
361 |
361 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,477 |
1,469 |
$24K |
| D7230 |
|
111 |
62 |
$21K |
| D1120 |
Prophylaxis - child |
290 |
289 |
$15K |
| D2160 |
|
134 |
74 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,475 |
545 |
$10K |
| D0274 |
Bitewings - four radiographic images |
336 |
336 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$6K |
| D1320 |
|
216 |
215 |
$4K |
| D7220 |
|
24 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
285 |
270 |
$3K |
| D2140 |
|
39 |
26 |
$2K |
| D0270 |
|
31 |
29 |
$145.00 |