| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
568 |
430 |
$378K |
| D1110 |
Prophylaxis - adult |
5,146 |
4,788 |
$242K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,371 |
499 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,787 |
1,067 |
$121K |
| D9450 |
|
5,748 |
4,544 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,173 |
2,947 |
$97K |
| D2950 |
|
534 |
413 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
4,016 |
3,741 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,488 |
1,391 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,224 |
1,125 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
870 |
499 |
$44K |
| D0330 |
Panoramic radiographic image |
683 |
614 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
495 |
321 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,272 |
2,066 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
38 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
400 |
380 |
$26K |
| D1120 |
Prophylaxis - child |
528 |
496 |
$25K |
| D1206 |
Topical application of fluoride varnish |
514 |
478 |
$12K |
| D2954 |
|
55 |
44 |
$9K |
| D9110 |
|
264 |
239 |
$9K |
| D2330 |
|
96 |
47 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
607 |
319 |
$5K |
| D2331 |
|
48 |
30 |
$4K |
| D4342 |
|
39 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
24 |
$3K |
| D2394 |
|
22 |
16 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$438.47 |
| D0272 |
Bitewings - two radiographic images |
20 |
17 |
$424.00 |
| D0270 |
|
22 |
17 |
$227.00 |