| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
608 |
446 |
$408K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,290 |
1,565 |
$195K |
| D1110 |
Prophylaxis - adult |
4,052 |
4,031 |
$181K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,897 |
1,129 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
3,720 |
3,592 |
$122K |
| D2950 |
|
743 |
575 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,124 |
1,269 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,252 |
2,135 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,782 |
3,768 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,943 |
2,920 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
647 |
499 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,034 |
4,856 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,208 |
2,198 |
$60K |
| D4346 |
|
516 |
516 |
$33K |
| D0330 |
Panoramic radiographic image |
654 |
650 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,954 |
2,984 |
$27K |
| D1120 |
Prophylaxis - child |
606 |
603 |
$23K |
| D4355 |
|
204 |
204 |
$19K |
| D1351 |
Sealant - per tooth |
570 |
66 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,112 |
1,108 |
$15K |
| D4341 |
|
101 |
43 |
$15K |
| D2331 |
|
163 |
114 |
$13K |
| D2791 |
|
15 |
15 |
$9K |
| D2330 |
|
160 |
97 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
54 |
$5K |
| D7250 |
|
64 |
41 |
$5K |
| D4910 |
|
40 |
40 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
233 |
230 |
$3K |
| D2335 |
|
17 |
14 |
$3K |
| D1354 |
|
85 |
20 |
$2K |
| D0270 |
|
130 |
130 |
$2K |
| D3120 |
|
15 |
13 |
$0.00 |
| D0431 |
|
34 |
34 |
$0.00 |