| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
715 |
451 |
$451K |
| D1110 |
Prophylaxis - adult |
7,378 |
7,046 |
$392K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,106 |
2,457 |
$357K |
| D0120 |
Periodic oral evaluation - established patient |
8,130 |
7,788 |
$196K |
| D1120 |
Prophylaxis - child |
3,853 |
3,690 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,612 |
1,602 |
$180K |
| D0274 |
Bitewings - four radiographic images |
4,641 |
4,439 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,557 |
2,437 |
$112K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
774 |
443 |
$101K |
| D0140 |
Limited oral evaluation - problem focused |
2,263 |
2,185 |
$89K |
| D1206 |
Topical application of fluoride varnish |
3,450 |
3,384 |
$87K |
| D1351 |
Sealant - per tooth |
1,705 |
456 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,979 |
1,844 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
522 |
391 |
$46K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
74 |
52 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,452 |
2,354 |
$37K |
| D0330 |
Panoramic radiographic image |
568 |
542 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,027 |
980 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
302 |
174 |
$27K |
| D2954 |
|
132 |
105 |
$24K |
| D2950 |
|
72 |
48 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
745 |
663 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
60 |
$4K |
| D2335 |
|
19 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
14 |
$2K |
| D3120 |
|
28 |
26 |
$1K |
| D2330 |
|
19 |
13 |
$723.00 |