| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
527 |
421 |
$249K |
| D1110 |
Prophylaxis - adult |
1,532 |
1,531 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
2,101 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,210 |
1,210 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,017 |
565 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,990 |
3,996 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,866 |
2,859 |
$59K |
| D2954 |
|
472 |
396 |
$49K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
87 |
85 |
$40K |
| D1120 |
Prophylaxis - child |
769 |
763 |
$25K |
| D9430 |
|
693 |
686 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,898 |
1,876 |
$22K |
| D2160 |
|
255 |
164 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
37 |
$7K |
| D3320 |
|
16 |
14 |
$6K |
| D2330 |
|
72 |
29 |
$5K |
| D9110 |
|
92 |
88 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
27 |
$4K |
| D2140 |
|
30 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$153.00 |
| D1999 |
|
764 |
623 |
$20.00 |