| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
557 |
317 |
$382K |
| D1110 |
Prophylaxis - adult |
2,967 |
2,722 |
$154K |
| D8670 |
Periodic orthodontic treatment visit |
576 |
503 |
$122K |
| D0274 |
Bitewings - four radiographic images |
2,771 |
2,544 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,124 |
644 |
$94K |
| D2950 |
|
551 |
374 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,358 |
3,092 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,422 |
1,324 |
$54K |
| D1120 |
Prophylaxis - child |
1,119 |
1,046 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
911 |
453 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,959 |
2,642 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,459 |
1,341 |
$41K |
| D1351 |
Sealant - per tooth |
867 |
193 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
624 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,417 |
1,919 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
368 |
$27K |
| D9310 |
|
312 |
281 |
$16K |
| D4342 |
|
181 |
67 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
153 |
86 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
89 |
37 |
$10K |
| D0330 |
Panoramic radiographic image |
76 |
69 |
$3K |
| D8660 |
|
55 |
47 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
39 |
$1K |
| D1206 |
Topical application of fluoride varnish |
34 |
33 |
$896.00 |
| D3120 |
|
16 |
14 |
$506.00 |
| D0350 |
|
67 |
53 |
$0.00 |
| D0340 |
|
37 |
31 |
$0.00 |
| D0470 |
|
55 |
41 |
$0.00 |