| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,094 |
511 |
$461K |
| D0120 |
Periodic oral evaluation - established patient |
3,574 |
3,512 |
$342K |
| D0220 |
Intraoral - periapical first radiographic image |
5,292 |
4,698 |
$341K |
| D0140 |
Limited oral evaluation - problem focused |
2,986 |
2,764 |
$232K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,776 |
618 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,177 |
1,139 |
$116K |
| D4341 |
|
647 |
173 |
$110K |
| D0330 |
Panoramic radiographic image |
1,179 |
1,143 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,084 |
3,013 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
811 |
442 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
565 |
320 |
$55K |
| D2160 |
|
858 |
406 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
415 |
236 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,711 |
1,882 |
$37K |
| D2950 |
|
525 |
299 |
$33K |
| D1110 |
Prophylaxis - adult |
1,047 |
1,018 |
$26K |
| D1120 |
Prophylaxis - child |
1,499 |
1,476 |
$19K |
| D0272 |
Bitewings - two radiographic images |
966 |
941 |
$19K |
| D2140 |
|
356 |
191 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
114 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,702 |
1,671 |
$11K |
| D9420 |
|
29 |
29 |
$8K |
| D1351 |
Sealant - per tooth |
189 |
52 |
$3K |
| D2161 |
|
49 |
30 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$2K |
| D0350 |
|
17 |
17 |
$0.00 |