| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
662 |
504 |
$244K |
| D1110 |
Prophylaxis - adult |
5,450 |
5,186 |
$180K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,728 |
1,808 |
$175K |
| D2950 |
|
1,324 |
1,166 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
7,092 |
6,731 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
3,954 |
3,805 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
2,057 |
2,029 |
$83K |
| D0274 |
Bitewings - four radiographic images |
5,715 |
5,392 |
$70K |
| D4910 |
|
1,162 |
1,125 |
$64K |
| D4341 |
|
728 |
266 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,442 |
4,201 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
8,677 |
8,171 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,508 |
2,355 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,023 |
733 |
$48K |
| D0330 |
Panoramic radiographic image |
3,731 |
3,531 |
$45K |
| D1120 |
Prophylaxis - child |
1,940 |
1,801 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,192 |
4,790 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,844 |
2,696 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
507 |
385 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,149 |
2,014 |
$25K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
58 |
53 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
189 |
$18K |
| D0270 |
|
1,708 |
1,647 |
$9K |
| D0180 |
|
371 |
363 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
19 |
$2K |
| D2332 |
|
15 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
61 |
13 |
$1K |
| D0460 |
|
157 |
153 |
$985.26 |
| D2331 |
|
16 |
12 |
$934.50 |
| D1999 |
|
3,794 |
3,162 |
$15.00 |