| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,026 |
1,337 |
$1.41M |
| D1110 |
Prophylaxis - adult |
12,073 |
11,891 |
$651K |
| D0120 |
Periodic oral evaluation - established patient |
14,665 |
14,454 |
$351K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
596 |
370 |
$328K |
| D2954 |
|
1,749 |
1,162 |
$320K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,222 |
2,214 |
$253K |
| D0272 |
Bitewings - two radiographic images |
8,590 |
8,496 |
$223K |
| D3320 |
|
417 |
335 |
$219K |
| D1120 |
Prophylaxis - child |
3,972 |
3,940 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,424 |
6,381 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,558 |
1,311 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,271 |
1,457 |
$176K |
| D0330 |
Panoramic radiographic image |
2,134 |
2,096 |
$132K |
| D9110 |
|
3,020 |
2,935 |
$121K |
| D1351 |
Sealant - per tooth |
2,650 |
598 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
6,451 |
6,247 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
677 |
503 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,903 |
1,876 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
864 |
840 |
$60K |
| D3310 |
|
127 |
73 |
$55K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
73 |
65 |
$51K |
| D2330 |
|
512 |
271 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
215 |
170 |
$17K |
| D4341 |
|
76 |
21 |
$10K |
| D5211 |
|
14 |
12 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
321 |
$5K |
| D2950 |
|
29 |
24 |
$5K |
| D2332 |
|
33 |
24 |
$4K |
| D2331 |
|
18 |
13 |
$2K |