| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
823 |
592 |
$421K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,798 |
474 |
$223K |
| D1110 |
Prophylaxis - adult |
2,451 |
2,367 |
$102K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
152 |
137 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,174 |
248 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,347 |
2,255 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,645 |
2,555 |
$66K |
| D3320 |
|
108 |
97 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,636 |
1,593 |
$34K |
| D0330 |
Panoramic radiographic image |
779 |
757 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
389 |
181 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,496 |
2,245 |
$28K |
| D4355 |
|
407 |
392 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
660 |
646 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
564 |
540 |
$11K |
| D5110 |
|
14 |
14 |
$10K |
| D3310 |
|
20 |
13 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,735 |
1,135 |
$8K |
| D2140 |
|
129 |
78 |
$8K |
| D5212 |
|
12 |
12 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
43 |
$5K |
| D0367 |
|
59 |
55 |
$3K |
| D2950 |
|
70 |
58 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
33 |
$2K |
| D1120 |
Prophylaxis - child |
63 |
62 |
$2K |
| D2160 |
|
17 |
13 |
$1K |
| D0160 |
|
18 |
16 |
$670.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$492.50 |