| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,422 |
815 |
$974K |
| D1110 |
Prophylaxis - adult |
5,497 |
5,370 |
$289K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,705 |
889 |
$229K |
| D2950 |
|
1,390 |
854 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
6,371 |
6,254 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
1,533 |
1,490 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,640 |
742 |
$103K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
202 |
128 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
5,550 |
5,334 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,385 |
2,319 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,087 |
575 |
$83K |
| D1120 |
Prophylaxis - child |
1,595 |
1,563 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,894 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,676 |
2,623 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,888 |
1,822 |
$73K |
| D4342 |
|
710 |
216 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,284 |
3,634 |
$57K |
| D4341 |
|
429 |
115 |
$50K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
14 |
$12K |
| D9110 |
|
139 |
134 |
$7K |
| D1351 |
Sealant - per tooth |
161 |
41 |
$6K |
| D0330 |
Panoramic radiographic image |
109 |
100 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
25 |
$3K |
| D2332 |
|
28 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
89 |
87 |
$2K |
| D0180 |
|
46 |
42 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$758.00 |