| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,508 |
1,079 |
$785K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,565 |
1,950 |
$478K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,691 |
1,528 |
$282K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,477 |
767 |
$240K |
| D2950 |
|
1,306 |
936 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
937 |
667 |
$151K |
| D0210 |
Intraoral - complete series of radiographic images |
1,674 |
1,662 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,710 |
2,696 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
614 |
358 |
$98K |
| D1110 |
Prophylaxis - adult |
1,613 |
1,604 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,018 |
2,011 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,149 |
1,137 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,292 |
1,288 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,313 |
2,267 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
797 |
792 |
$24K |
| D4342 |
|
185 |
85 |
$20K |
| D2330 |
|
122 |
90 |
$12K |
| D4341 |
|
26 |
13 |
$7K |
| D2394 |
|
31 |
25 |
$6K |
| D1206 |
Topical application of fluoride varnish |
291 |
289 |
$5K |
| D2331 |
|
35 |
24 |
$4K |
| D0460 |
|
138 |
135 |
$4K |
| D2332 |
|
20 |
13 |
$3K |
| D0180 |
|
12 |
12 |
$492.12 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$453.15 |