| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
919 |
597 |
$434K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,558 |
2,552 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,289 |
2,277 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
2,157 |
2,152 |
$91K |
| D1110 |
Prophylaxis - adult |
1,034 |
1,030 |
$79K |
| D2954 |
|
637 |
454 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
626 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
785 |
455 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,894 |
2,735 |
$45K |
| D1120 |
Prophylaxis - child |
1,200 |
1,194 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,183 |
2,167 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
334 |
182 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
352 |
$31K |
| D9430 |
|
889 |
816 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
38 |
37 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
113 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
970 |
966 |
$10K |
| D2160 |
|
132 |
74 |
$10K |
| D4341 |
|
106 |
29 |
$7K |
| D2140 |
|
129 |
95 |
$6K |
| D0350 |
|
268 |
70 |
$2K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$1K |
| D1351 |
Sealant - per tooth |
47 |
12 |
$990.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$963.20 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$644.00 |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
119 |
$377.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$106.00 |
| D0270 |
|
12 |
12 |
$60.50 |