| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,942 |
1,148 |
$1.29M |
| D1110 |
Prophylaxis - adult |
13,045 |
12,673 |
$668K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
915 |
504 |
$475K |
| D9243 |
|
4,934 |
1,033 |
$398K |
| D0210 |
Intraoral - complete series of radiographic images |
5,230 |
5,088 |
$356K |
| D0274 |
Bitewings - four radiographic images |
8,483 |
8,169 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
11,009 |
10,675 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,070 |
1,867 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,530 |
5,374 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
13,176 |
12,584 |
$195K |
| D2950 |
|
1,035 |
635 |
$158K |
| D4342 |
|
1,990 |
806 |
$157K |
| D0140 |
Limited oral evaluation - problem focused |
4,039 |
3,888 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,043 |
9,803 |
$135K |
| D7250 |
|
982 |
239 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,678 |
5,528 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,647 |
407 |
$115K |
| D0330 |
Panoramic radiographic image |
1,729 |
1,646 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
700 |
382 |
$95K |
| D1120 |
Prophylaxis - child |
1,921 |
1,860 |
$89K |
| D9239 |
|
1,095 |
1,020 |
$89K |
| D2335 |
|
584 |
272 |
$78K |
| D7240 |
Removal of impacted tooth - completely bony |
126 |
42 |
$41K |
| D3120 |
|
1,141 |
668 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
510 |
317 |
$32K |
| D2332 |
|
296 |
118 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
347 |
241 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,134 |
1,108 |
$25K |
| D4346 |
|
320 |
318 |
$19K |
| D9450 |
|
1,413 |
1,057 |
$16K |
| D7230 |
|
46 |
28 |
$11K |
| D2161 |
|
97 |
66 |
$10K |
| D1351 |
Sealant - per tooth |
233 |
60 |
$9K |
| D2954 |
|
54 |
37 |
$9K |
| D5110 |
|
16 |
13 |
$8K |
| D4341 |
|
52 |
24 |
$6K |
| D5211 |
|
13 |
13 |
$6K |
| D9110 |
|
72 |
68 |
$3K |
| D0272 |
Bitewings - two radiographic images |
62 |
59 |
$2K |
| D2160 |
|
16 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
59 |
$756.00 |
| D0270 |
|
40 |
40 |
$537.00 |
| D4910 |
|
55 |
53 |
$0.00 |
| D0431 |
|
39 |
38 |
$0.00 |