| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,629 |
860 |
$1.02M |
| D1110 |
Prophylaxis - adult |
9,253 |
8,456 |
$445K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,299 |
1,884 |
$246K |
| D0210 |
Intraoral - complete series of radiographic images |
3,738 |
3,404 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
9,473 |
8,803 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
5,626 |
5,046 |
$200K |
| D0274 |
Bitewings - four radiographic images |
5,863 |
5,376 |
$197K |
| D1120 |
Prophylaxis - child |
3,965 |
3,744 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,486 |
4,086 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,364 |
5,033 |
$146K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,007 |
516 |
$122K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
212 |
136 |
$108K |
| D1351 |
Sealant - per tooth |
2,932 |
645 |
$106K |
| D2954 |
|
631 |
412 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,812 |
958 |
$99K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
110 |
98 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,139 |
4,595 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
578 |
372 |
$55K |
| D2950 |
|
355 |
265 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
256 |
$31K |
| D0330 |
Panoramic radiographic image |
977 |
881 |
$29K |
| D3320 |
|
43 |
36 |
$19K |
| D0272 |
Bitewings - two radiographic images |
623 |
588 |
$17K |
| D8670 |
Periodic orthodontic treatment visit |
37 |
26 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
263 |
$4K |
| D2331 |
|
48 |
37 |
$4K |
| D4341 |
|
29 |
13 |
$3K |
| D2394 |
|
13 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$702.00 |
| D0270 |
|
26 |
25 |
$331.00 |
| D9310 |
|
24 |
14 |
$189.00 |