| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,158 |
901 |
$834K |
| D1110 |
Prophylaxis - adult |
10,007 |
9,922 |
$544K |
| D0274 |
Bitewings - four radiographic images |
7,980 |
7,916 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
10,433 |
10,354 |
$255K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,485 |
4,461 |
$198K |
| D1120 |
Prophylaxis - child |
3,724 |
3,708 |
$192K |
| D2950 |
|
1,128 |
937 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,038 |
6,010 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
2,141 |
2,129 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,840 |
3,767 |
$149K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,772 |
959 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
8,102 |
7,910 |
$129K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
181 |
117 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,308 |
583 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
607 |
372 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,869 |
3,707 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
320 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
632 |
365 |
$43K |
| D1351 |
Sealant - per tooth |
662 |
200 |
$28K |
| D4341 |
|
198 |
83 |
$25K |
| D2140 |
|
382 |
202 |
$22K |
| D0330 |
Panoramic radiographic image |
452 |
425 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
25 |
$18K |
| D3320 |
|
28 |
25 |
$16K |
| D4342 |
|
176 |
67 |
$16K |
| D2331 |
|
139 |
99 |
$12K |
| D2160 |
|
108 |
71 |
$9K |
| D3310 |
|
19 |
12 |
$7K |
| D5211 |
|
12 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
216 |
216 |
$6K |
| D2954 |
|
39 |
27 |
$6K |
| D2335 |
|
41 |
25 |
$6K |
| D2330 |
|
31 |
25 |
$2K |
| D1999 |
|
34 |
32 |
$0.00 |