| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
524 |
348 |
$357K |
| D1110 |
Prophylaxis - adult |
3,346 |
3,169 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
2,055 |
1,917 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,893 |
883 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,558 |
2,387 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,291 |
821 |
$102K |
| D0274 |
Bitewings - four radiographic images |
1,939 |
1,873 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,593 |
2,505 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,421 |
1,309 |
$54K |
| D1120 |
Prophylaxis - child |
884 |
837 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
598 |
216 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,364 |
2,194 |
$37K |
| D1351 |
Sealant - per tooth |
589 |
122 |
$24K |
| D2950 |
|
147 |
119 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,302 |
1,118 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
453 |
435 |
$13K |
| D4342 |
|
126 |
45 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D4341 |
|
34 |
13 |
$5K |
| D1206 |
Topical application of fluoride varnish |
147 |
143 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
25 |
$4K |
| D2330 |
|
84 |
25 |
$3K |
| D3120 |
|
18 |
13 |
$636.00 |
| D0272 |
Bitewings - two radiographic images |
21 |
18 |
$440.00 |