| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,308 |
989 |
$935K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,166 |
987 |
$806K |
| D1110 |
Prophylaxis - adult |
9,732 |
9,598 |
$537K |
| D8670 |
Periodic orthodontic treatment visit |
2,089 |
1,998 |
$518K |
| D2954 |
|
1,970 |
1,548 |
$370K |
| D0120 |
Periodic oral evaluation - established patient |
10,089 |
10,009 |
$247K |
| D0274 |
Bitewings - four radiographic images |
5,845 |
5,783 |
$219K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,819 |
1,404 |
$198K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,418 |
5,396 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
3,960 |
3,892 |
$155K |
| D1120 |
Prophylaxis - child |
2,240 |
2,234 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,599 |
1,560 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
6,754 |
6,594 |
$100K |
| D9110 |
|
2,044 |
2,006 |
$85K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
132 |
96 |
$75K |
| D0330 |
Panoramic radiographic image |
1,357 |
1,330 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,655 |
1,622 |
$72K |
| D1351 |
Sealant - per tooth |
1,013 |
216 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,651 |
1,089 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
83 |
$15K |
| D0272 |
Bitewings - two radiographic images |
384 |
383 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
73 |
$8K |
| D3310 |
|
17 |
13 |
$7K |
| D8660 |
|
152 |
147 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
42 |
$5K |
| D9310 |
|
69 |
59 |
$4K |
| D8680 |
|
13 |
13 |
$1K |
| D1999 |
|
218 |
207 |
$0.00 |