| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,248 |
927 |
$594K |
| D0120 |
Periodic oral evaluation - established patient |
7,601 |
7,576 |
$423K |
| D1110 |
Prophylaxis - adult |
4,416 |
4,391 |
$382K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,510 |
12,262 |
$291K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,079 |
2,434 |
$273K |
| D1120 |
Prophylaxis - child |
5,712 |
5,693 |
$216K |
| D4341 |
|
3,055 |
1,152 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,999 |
2,977 |
$189K |
| D0274 |
Bitewings - four radiographic images |
8,421 |
8,377 |
$180K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
248 |
242 |
$115K |
| D9110 |
|
1,281 |
1,179 |
$80K |
| D2160 |
|
957 |
667 |
$76K |
| D2954 |
|
684 |
561 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,058 |
690 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
572 |
421 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,697 |
5,678 |
$66K |
| D1351 |
Sealant - per tooth |
2,575 |
872 |
$65K |
| D9430 |
|
1,411 |
1,380 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
740 |
441 |
$42K |
| D0350 |
|
4,235 |
2,639 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
838 |
834 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,007 |
2,931 |
$36K |
| D2330 |
|
287 |
192 |
$22K |
| D2140 |
|
376 |
279 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
254 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
183 |
146 |
$15K |
| D3320 |
|
37 |
36 |
$14K |
| D4910 |
|
106 |
106 |
$8K |
| D4342 |
|
199 |
82 |
$8K |
| D0272 |
Bitewings - two radiographic images |
692 |
692 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |