| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
791 |
294 |
$650K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,312 |
952 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,401 |
1,209 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,926 |
881 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,689 |
927 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
1,649 |
1,506 |
$121K |
| D1110 |
Prophylaxis - adult |
2,655 |
2,497 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,899 |
2,740 |
$105K |
| D2394 |
|
888 |
535 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,050 |
2,845 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,892 |
2,687 |
$68K |
| D4342 |
|
792 |
203 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
608 |
235 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,708 |
2,514 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,204 |
3,449 |
$39K |
| D1120 |
Prophylaxis - child |
1,341 |
1,257 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,216 |
3,925 |
$34K |
| D2950 |
|
171 |
93 |
$28K |
| D2331 |
|
309 |
200 |
$27K |
| D0350 |
|
1,075 |
998 |
$23K |
| D0330 |
Panoramic radiographic image |
292 |
275 |
$22K |
| D2332 |
|
175 |
94 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
612 |
573 |
$19K |
| D1351 |
Sealant - per tooth |
488 |
131 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0240 |
|
333 |
141 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
47 |
$5K |
| D0272 |
Bitewings - two radiographic images |
181 |
165 |
$3K |
| D2335 |
|
15 |
12 |
$3K |
| D4910 |
|
89 |
84 |
$3K |
| D2160 |
|
40 |
26 |
$2K |
| D2330 |
|
41 |
24 |
$2K |
| D2140 |
|
31 |
13 |
$1K |
| D0701 |
|
37 |
31 |
$0.00 |