| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,060 |
834 |
$731K |
| D1110 |
Prophylaxis - adult |
11,994 |
11,753 |
$679K |
| D0120 |
Periodic oral evaluation - established patient |
15,184 |
14,979 |
$393K |
| D1120 |
Prophylaxis - child |
7,190 |
7,125 |
$369K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,359 |
11,265 |
$333K |
| D0210 |
Intraoral - complete series of radiographic images |
3,437 |
3,339 |
$259K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,008 |
1,691 |
$221K |
| D1351 |
Sealant - per tooth |
4,778 |
1,569 |
$195K |
| D0274 |
Bitewings - four radiographic images |
4,903 |
4,825 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,888 |
1,183 |
$183K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
245 |
181 |
$135K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,382 |
925 |
$116K |
| D2950 |
|
689 |
548 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,286 |
2,212 |
$101K |
| D2140 |
|
1,024 |
660 |
$70K |
| D0330 |
Panoramic radiographic image |
639 |
636 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
2,495 |
2,419 |
$39K |
| D4341 |
|
236 |
93 |
$32K |
| D2160 |
|
204 |
149 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
448 |
432 |
$18K |
| D0272 |
Bitewings - two radiographic images |
598 |
593 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
78 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
78 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
38 |
$8K |
| D9110 |
|
93 |
88 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
170 |
$3K |
| D9941 |
|
39 |
39 |
$3K |