| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
556 |
434 |
$263K |
| D1110 |
Prophylaxis - adult |
2,823 |
2,813 |
$247K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,647 |
2,639 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,263 |
1,433 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,537 |
1,440 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
1,703 |
1,694 |
$132K |
| D0350 |
|
7,534 |
2,891 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,508 |
1,503 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,642 |
3,307 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
443 |
308 |
$52K |
| D1120 |
Prophylaxis - child |
1,174 |
1,168 |
$51K |
| D4341 |
|
665 |
232 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,631 |
1,622 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
411 |
318 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,837 |
1,831 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
27 |
$13K |
| D0272 |
Bitewings - two radiographic images |
830 |
829 |
$10K |
| D1351 |
Sealant - per tooth |
452 |
120 |
$10K |
| D1206 |
Topical application of fluoride varnish |
676 |
671 |
$9K |
| D2330 |
|
99 |
63 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
56 |
$6K |
| D9430 |
|
198 |
197 |
$6K |
| D4910 |
|
70 |
70 |
$5K |
| D2954 |
|
50 |
46 |
$5K |
| D2332 |
|
14 |
12 |
$1K |
| D0270 |
|
13 |
13 |
$65.00 |