| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
921 |
592 |
$625K |
| D1110 |
Prophylaxis - adult |
5,224 |
5,116 |
$277K |
| D1120 |
Prophylaxis - child |
3,063 |
3,029 |
$152K |
| D0274 |
Bitewings - four radiographic images |
4,027 |
3,925 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
8,205 |
7,865 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,781 |
2,725 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,636 |
4,569 |
$115K |
| D0180 |
|
2,258 |
2,217 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,710 |
2,599 |
$102K |
| D9945 |
|
340 |
324 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,447 |
6,199 |
$86K |
| D1206 |
Topical application of fluoride varnish |
2,291 |
2,279 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,602 |
1,581 |
$49K |
| D1351 |
Sealant - per tooth |
1,111 |
263 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
308 |
190 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,112 |
1,096 |
$34K |
| D2950 |
|
159 |
130 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
238 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
290 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
40 |
35 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
265 |
137 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
239 |
126 |
$14K |
| D9110 |
|
153 |
149 |
$6K |
| D4341 |
|
36 |
12 |
$4K |
| D2954 |
|
15 |
14 |
$2K |