| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
996 |
729 |
$471K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,181 |
5,152 |
$342K |
| D1110 |
Prophylaxis - adult |
2,540 |
2,522 |
$224K |
| D0210 |
Intraoral - complete series of radiographic images |
4,528 |
4,503 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
2,233 |
2,214 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,993 |
1,218 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,125 |
529 |
$133K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,485 |
720 |
$100K |
| D4341 |
|
1,166 |
363 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,320 |
3,423 |
$71K |
| D4910 |
|
750 |
750 |
$58K |
| D1120 |
Prophylaxis - child |
1,198 |
1,183 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,582 |
3,547 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,143 |
2,118 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
430 |
$33K |
| D9430 |
|
672 |
660 |
$21K |
| D2160 |
|
231 |
147 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
204 |
142 |
$16K |
| D2954 |
|
88 |
79 |
$9K |
| D0330 |
Panoramic radiographic image |
207 |
207 |
$6K |
| D2330 |
|
48 |
32 |
$4K |
| D2140 |
|
49 |
35 |
$3K |
| D2331 |
|
14 |
12 |
$1K |
| D0350 |
|
113 |
48 |
$1K |
| D4342 |
|
26 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$744.00 |