| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
773 |
463 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
4,970 |
4,914 |
$284K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,456 |
1,554 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,206 |
1,705 |
$226K |
| D1110 |
Prophylaxis - adult |
2,630 |
2,610 |
$217K |
| D1120 |
Prophylaxis - child |
5,150 |
5,110 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,136 |
3,116 |
$199K |
| D9430 |
|
4,904 |
4,342 |
$156K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,664 |
722 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,213 |
2,201 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,910 |
7,849 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,446 |
770 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,989 |
6,389 |
$71K |
| D1351 |
Sealant - per tooth |
2,497 |
751 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,016 |
3,001 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
567 |
352 |
$45K |
| D2160 |
|
556 |
304 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,361 |
3,308 |
$40K |
| D2330 |
|
518 |
209 |
$39K |
| D0330 |
Panoramic radiographic image |
968 |
963 |
$28K |
| D0350 |
|
2,116 |
822 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
102 |
$17K |
| D2954 |
|
144 |
103 |
$15K |
| D4910 |
|
145 |
145 |
$11K |
| D2140 |
|
207 |
108 |
$11K |
| D1310 |
|
214 |
213 |
$9K |
| D4341 |
|
132 |
42 |
$9K |
| D9993 |
|
174 |
172 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
12 |
$8K |
| D4342 |
|
142 |
47 |
$6K |
| D9110 |
|
14 |
14 |
$882.00 |
| D0272 |
Bitewings - two radiographic images |
73 |
73 |
$873.00 |
| D0601 |
|
39 |
39 |
$540.00 |