| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
322 |
252 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,367 |
836 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
2,028 |
1,969 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,526 |
2,519 |
$75K |
| D1110 |
Prophylaxis - adult |
1,819 |
1,817 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,040 |
628 |
$70K |
| D2950 |
|
524 |
417 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,249 |
456 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,963 |
1,919 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
502 |
349 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
335 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,619 |
1,615 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,027 |
2,950 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,181 |
1,178 |
$30K |
| D4341 |
|
172 |
68 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,874 |
1,755 |
$19K |
| D1120 |
Prophylaxis - child |
350 |
350 |
$14K |
| D4910 |
|
173 |
173 |
$11K |
| D1206 |
Topical application of fluoride varnish |
369 |
369 |
$9K |
| D0330 |
Panoramic radiographic image |
250 |
249 |
$9K |
| D2332 |
|
32 |
12 |
$3K |
| D4355 |
|
89 |
89 |
$3K |
| D4346 |
|
34 |
34 |
$2K |
| D4342 |
|
32 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$295.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$224.00 |