| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,100 |
610 |
$785K |
| D1110 |
Prophylaxis - adult |
7,683 |
7,354 |
$394K |
| D0210 |
Intraoral - complete series of radiographic images |
2,621 |
2,491 |
$183K |
| D0274 |
Bitewings - four radiographic images |
4,888 |
4,680 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
7,472 |
7,092 |
$166K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
246 |
138 |
$138K |
| D1120 |
Prophylaxis - child |
1,921 |
1,808 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,150 |
2,046 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,930 |
2,798 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,287 |
752 |
$70K |
| D2954 |
|
356 |
236 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,454 |
1,384 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
832 |
564 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,145 |
2,965 |
$45K |
| D2330 |
|
383 |
144 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
118 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
53 |
$8K |
| D2335 |
|
48 |
26 |
$6K |
| D1351 |
Sealant - per tooth |
133 |
28 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
25 |
$4K |
| D9110 |
|
91 |
81 |
$3K |
| D0330 |
Panoramic radiographic image |
59 |
46 |
$3K |
| D2140 |
|
46 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
174 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
30 |
$841.00 |