| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,443 |
1,997 |
$738K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,508 |
1,410 |
$471K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,191 |
1,911 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,234 |
2,541 |
$172K |
| D1110 |
Prophylaxis - adult |
2,305 |
2,277 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
6,939 |
6,650 |
$132K |
| D2950 |
|
3,044 |
2,451 |
$95K |
| D3310 |
|
429 |
269 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,499 |
5,460 |
$92K |
| D3320 |
|
286 |
255 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,937 |
4,889 |
$50K |
| D2332 |
|
986 |
495 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,608 |
1,573 |
$17K |
| D0603 |
|
4,287 |
4,214 |
$11K |
| D1351 |
Sealant - per tooth |
947 |
185 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,574 |
5,237 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,628 |
2,599 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
1,829 |
1,805 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
383 |
283 |
$6K |
| D1120 |
Prophylaxis - child |
104 |
104 |
$3K |
| D1330 |
|
2,686 |
2,657 |
$2K |
| D2331 |
|
40 |
27 |
$1K |
| D2335 |
|
25 |
16 |
$509.37 |
| D2330 |
|
14 |
12 |
$210.00 |
| D0601 |
|
85 |
85 |
$140.00 |
| D9986 |
|
1,784 |
1,655 |
$0.00 |
| D0350 |
|
29 |
29 |
$0.00 |
| D0602 |
|
19 |
19 |
$0.00 |
| D0240 |
|
12 |
12 |
$0.00 |