| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,309 |
847 |
$908K |
| D1110 |
Prophylaxis - adult |
8,672 |
8,518 |
$448K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
371 |
227 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
9,043 |
8,896 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
2,357 |
2,301 |
$164K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,950 |
1,119 |
$135K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,524 |
922 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,251 |
3,193 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,256 |
680 |
$71K |
| D1120 |
Prophylaxis - child |
1,019 |
1,004 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,213 |
3,024 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,337 |
1,323 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
304 |
144 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
732 |
$30K |
| D9110 |
|
674 |
643 |
$23K |
| D2950 |
|
114 |
80 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
14 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
939 |
713 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
49 |
$6K |
| D1206 |
Topical application of fluoride varnish |
93 |
93 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$822.00 |