| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,070 |
426 |
$987K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,658 |
869 |
$398K |
| D0210 |
Intraoral - complete series of radiographic images |
4,278 |
3,951 |
$340K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,797 |
1,314 |
$282K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,259 |
668 |
$261K |
| D2950 |
|
1,514 |
692 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,510 |
4,200 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,310 |
719 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,820 |
841 |
$158K |
| D1110 |
Prophylaxis - adult |
3,361 |
3,150 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
5,670 |
5,232 |
$135K |
| D5110 |
|
89 |
79 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,164 |
2,001 |
$65K |
| D1120 |
Prophylaxis - child |
2,235 |
2,082 |
$63K |
| D3310 |
|
128 |
55 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,893 |
1,761 |
$43K |
| D0350 |
|
1,808 |
1,728 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
928 |
832 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,086 |
2,784 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,026 |
1,287 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,016 |
955 |
$17K |
| D5214 |
|
13 |
13 |
$15K |
| D2394 |
|
89 |
66 |
$13K |
| D5120 |
|
13 |
12 |
$11K |
| D3320 |
|
18 |
13 |
$10K |
| D0330 |
Panoramic radiographic image |
181 |
162 |
$9K |
| D4342 |
|
94 |
41 |
$8K |
| D7310 |
|
30 |
12 |
$6K |
| D2954 |
|
40 |
13 |
$5K |
| D2332 |
|
38 |
16 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
27 |
$2K |
| D1320 |
|
26 |
25 |
$345.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$343.91 |
| D0270 |
|
12 |
12 |
$122.80 |