| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
393 |
236 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,591 |
780 |
$207K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
970 |
315 |
$193K |
| D1351 |
Sealant - per tooth |
2,941 |
458 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,441 |
$75K |
| D2950 |
|
358 |
268 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,213 |
1,187 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
589 |
333 |
$59K |
| D1110 |
Prophylaxis - adult |
1,014 |
1,011 |
$56K |
| D1120 |
Prophylaxis - child |
1,155 |
1,154 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
647 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,276 |
2,239 |
$40K |
| D0330 |
Panoramic radiographic image |
610 |
608 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
232 |
163 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,531 |
1,529 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,003 |
1,003 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,204 |
1,608 |
$22K |
| D7261 |
|
53 |
39 |
$21K |
| D0274 |
Bitewings - four radiographic images |
607 |
607 |
$20K |
| D9243 |
|
71 |
15 |
$9K |
| D9239 |
|
16 |
15 |
$3K |
| D2332 |
|
19 |
14 |
$3K |
| D2331 |
|
15 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$845.75 |
| D0270 |
|
48 |
47 |
$615.18 |