| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
502 |
329 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,937 |
1,931 |
$128K |
| D1110 |
Prophylaxis - adult |
1,133 |
1,132 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
998 |
997 |
$75K |
| D1120 |
Prophylaxis - child |
1,384 |
1,380 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,213 |
1,211 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,804 |
2,128 |
$49K |
| D4341 |
|
580 |
165 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
122 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,055 |
1,054 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,178 |
1,175 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,122 |
1,120 |
$16K |
| D2954 |
|
121 |
86 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
176 |
95 |
$12K |
| D4910 |
|
137 |
137 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
677 |
$9K |
| D9430 |
|
158 |
153 |
$5K |
| D0272 |
Bitewings - two radiographic images |
206 |
206 |
$2K |
| D1310 |
|
55 |
55 |
$2K |
| D4342 |
|
36 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$1K |
| D2160 |
|
16 |
12 |
$1K |
| D0350 |
|
41 |
13 |
$384.00 |