| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,170 |
723 |
$837K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,442 |
1,213 |
$332K |
| D1110 |
Prophylaxis - adult |
3,668 |
3,600 |
$191K |
| D0140 |
Limited oral evaluation - problem focused |
4,756 |
4,527 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
6,774 |
6,066 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,177 |
774 |
$85K |
| D0274 |
Bitewings - four radiographic images |
1,688 |
1,650 |
$58K |
| D2950 |
|
347 |
248 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,283 |
1,249 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,958 |
1,921 |
$42K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
75 |
50 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
501 |
345 |
$40K |
| D9110 |
|
1,158 |
1,086 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,849 |
2,460 |
$37K |
| D2954 |
|
182 |
131 |
$33K |
| D0330 |
Panoramic radiographic image |
543 |
521 |
$31K |
| D7230 |
|
131 |
74 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
338 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
94 |
$17K |
| D3120 |
|
469 |
312 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
309 |
188 |
$15K |
| D2335 |
|
92 |
53 |
$12K |
| D3320 |
|
14 |
13 |
$8K |
| D2394 |
|
69 |
58 |
$7K |
| D2332 |
|
35 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
122 |
114 |
$3K |
| D0270 |
|
274 |
238 |
$3K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$1K |