| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,075 |
757 |
$508K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,097 |
1,940 |
$473K |
| D1110 |
Prophylaxis - adult |
3,823 |
3,789 |
$310K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,479 |
4,462 |
$278K |
| D0120 |
Periodic oral evaluation - established patient |
5,179 |
5,151 |
$260K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,653 |
2,009 |
$242K |
| D1120 |
Prophylaxis - child |
5,533 |
5,503 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41,463 |
10,933 |
$169K |
| D0274 |
Bitewings - four radiographic images |
6,219 |
6,165 |
$129K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
240 |
214 |
$110K |
| D2952 |
|
931 |
666 |
$97K |
| D2160 |
|
1,198 |
851 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
985 |
513 |
$56K |
| D9430 |
|
1,667 |
1,648 |
$53K |
| D3320 |
|
137 |
117 |
$50K |
| D4341 |
|
653 |
249 |
$45K |
| D2140 |
|
676 |
422 |
$36K |
| D1351 |
Sealant - per tooth |
1,143 |
241 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
451 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,067 |
1,062 |
$12K |
| D0330 |
Panoramic radiographic image |
385 |
382 |
$11K |
| D1206 |
Topical application of fluoride varnish |
577 |
568 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
162 |
161 |
$2K |
| D2335 |
|
19 |
12 |
$2K |
| D7220 |
|
15 |
13 |
$2K |
| D2330 |
|
20 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$677.00 |
| D1999 |
|
13 |
13 |
$10.00 |