| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,266 |
950 |
$883K |
| D1110 |
Prophylaxis - adult |
11,213 |
10,960 |
$588K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,551 |
1,144 |
$354K |
| D0210 |
Intraoral - complete series of radiographic images |
4,215 |
4,100 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,424 |
2,486 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
10,778 |
10,531 |
$239K |
| D2954 |
|
1,200 |
948 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,440 |
2,189 |
$202K |
| D0330 |
Panoramic radiographic image |
2,946 |
2,828 |
$195K |
| D0274 |
Bitewings - four radiographic images |
4,803 |
4,687 |
$171K |
| D9110 |
|
4,602 |
4,356 |
$165K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
290 |
224 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,975 |
1,573 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,471 |
3,373 |
$142K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
170 |
157 |
$121K |
| D1120 |
Prophylaxis - child |
2,108 |
2,068 |
$106K |
| D3320 |
|
186 |
159 |
$97K |
| D2335 |
|
699 |
469 |
$95K |
| D4341 |
|
721 |
270 |
$90K |
| D2394 |
|
825 |
663 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,883 |
2,827 |
$82K |
| D2332 |
|
735 |
485 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
5,503 |
4,966 |
$79K |
| D2331 |
|
772 |
535 |
$64K |
| D5212 |
|
67 |
64 |
$38K |
| D1354 |
|
1,922 |
1,202 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
223 |
$23K |
| D5211 |
|
39 |
37 |
$21K |
| D2330 |
|
281 |
190 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,281 |
1,628 |
$13K |
| D3310 |
|
19 |
13 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
168 |
$7K |
| D1206 |
Topical application of fluoride varnish |
123 |
120 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$446.00 |