| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
493 |
412 |
$313K |
| D1351 |
Sealant - per tooth |
10,690 |
1,879 |
$304K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,502 |
1,508 |
$262K |
| D1110 |
Prophylaxis - adult |
3,285 |
3,270 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,548 |
4,526 |
$110K |
| D0274 |
Bitewings - four radiographic images |
3,245 |
3,232 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,668 |
2,658 |
$91K |
| D2950 |
|
553 |
485 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,708 |
1,628 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,307 |
507 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,227 |
2,192 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
5,561 |
5,423 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,103 |
3,936 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
350 |
$61K |
| D1120 |
Prophylaxis - child |
1,478 |
1,469 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
641 |
459 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
447 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,929 |
1,928 |
$44K |
| D0330 |
Panoramic radiographic image |
801 |
794 |
$31K |
| D4341 |
|
189 |
79 |
$28K |
| D5214 |
|
28 |
28 |
$23K |
| D4910 |
|
230 |
229 |
$19K |
| D5213 |
|
12 |
12 |
$9K |
| D4346 |
|
102 |
102 |
$6K |
| D4342 |
|
74 |
26 |
$5K |
| D0270 |
|
348 |
346 |
$3K |
| D2331 |
|
20 |
15 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
52 |
$1K |
| D3120 |
|
13 |
12 |
$0.00 |