| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,217 |
966 |
$664K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,270 |
1,354 |
$309K |
| D0350 |
|
4,102 |
3,276 |
$296K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,612 |
939 |
$264K |
| D0330 |
Panoramic radiographic image |
4,034 |
4,027 |
$211K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,169 |
787 |
$193K |
| D2950 |
|
1,237 |
1,009 |
$158K |
| D0140 |
Limited oral evaluation - problem focused |
4,266 |
4,092 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,172 |
3,166 |
$132K |
| D4342 |
|
1,318 |
490 |
$127K |
| D1110 |
Prophylaxis - adult |
2,264 |
2,258 |
$109K |
| D4341 |
|
416 |
158 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,355 |
3,347 |
$100K |
| D0460 |
|
2,831 |
2,318 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
696 |
413 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,292 |
2,284 |
$57K |
| D4910 |
|
650 |
647 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,440 |
1,428 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,007 |
2,893 |
$38K |
| D2394 |
|
166 |
128 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
334 |
137 |
$32K |
| D1206 |
Topical application of fluoride varnish |
923 |
919 |
$20K |
| D2335 |
|
51 |
27 |
$10K |
| D1120 |
Prophylaxis - child |
236 |
236 |
$9K |
| D0180 |
|
26 |
26 |
$1K |
| D9310 |
|
25 |
25 |
$968.49 |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$408.04 |