| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
789 |
558 |
$375K |
| D1110 |
Prophylaxis - adult |
2,667 |
2,658 |
$229K |
| D0120 |
Periodic oral evaluation - established patient |
3,950 |
3,928 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,917 |
2,909 |
$180K |
| D0210 |
Intraoral - complete series of radiographic images |
2,844 |
2,837 |
$133K |
| D1120 |
Prophylaxis - child |
2,990 |
2,978 |
$116K |
| D9430 |
|
2,466 |
2,276 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,160 |
658 |
$76K |
| D1206 |
Topical application of fluoride varnish |
4,930 |
4,914 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,836 |
4,217 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,225 |
2,219 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
364 |
149 |
$43K |
| D4341 |
|
542 |
150 |
$38K |
| D1351 |
Sealant - per tooth |
1,254 |
276 |
$36K |
| D0350 |
|
3,670 |
1,631 |
$34K |
| D4910 |
|
434 |
434 |
$33K |
| D0330 |
Panoramic radiographic image |
1,095 |
1,094 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,057 |
2,019 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
353 |
223 |
$19K |
| D2954 |
|
121 |
84 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
685 |
682 |
$10K |
| D0272 |
Bitewings - two radiographic images |
355 |
354 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
37 |
$4K |
| D4342 |
|
38 |
12 |
$2K |