| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
731 |
397 |
$452K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,663 |
391 |
$359K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,113 |
374 |
$217K |
| D1110 |
Prophylaxis - adult |
2,557 |
2,350 |
$189K |
| D0274 |
Bitewings - four radiographic images |
3,442 |
3,171 |
$181K |
| D2950 |
|
981 |
493 |
$156K |
| D0330 |
Panoramic radiographic image |
1,691 |
1,546 |
$143K |
| D1351 |
Sealant - per tooth |
2,600 |
202 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,970 |
1,811 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
1,491 |
1,386 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,088 |
1,968 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
221 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
2,035 |
1,898 |
$44K |
| D1120 |
Prophylaxis - child |
578 |
548 |
$33K |
| D1206 |
Topical application of fluoride varnish |
938 |
890 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
918 |
859 |
$23K |
| D9211 |
|
339 |
99 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
482 |
461 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
89 |
$7K |
| D0272 |
Bitewings - two radiographic images |
57 |
56 |
$2K |