| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,183 |
740 |
$556K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,855 |
1,940 |
$255K |
| D1110 |
Prophylaxis - adult |
2,185 |
2,173 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,936 |
1,536 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,077 |
2,067 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,490 |
997 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
1,393 |
1,383 |
$111K |
| D0350 |
|
9,041 |
2,965 |
$79K |
| D2330 |
|
925 |
486 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,487 |
1,479 |
$70K |
| D2952 |
|
486 |
355 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,831 |
2,676 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,115 |
3,098 |
$44K |
| D4910 |
|
531 |
531 |
$40K |
| D9430 |
|
1,226 |
1,179 |
$37K |
| D4341 |
|
498 |
146 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,614 |
1,608 |
$34K |
| D1120 |
Prophylaxis - child |
675 |
672 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
138 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
82 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$7K |
| D2331 |
|
68 |
40 |
$5K |
| D2394 |
|
50 |
41 |
$4K |
| D0330 |
Panoramic radiographic image |
121 |
121 |
$4K |
| D1351 |
Sealant - per tooth |
160 |
44 |
$3K |
| D2332 |
|
37 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
220 |
$3K |
| D0270 |
|
200 |
195 |
$990.00 |
| D1330 |
|
1,278 |
1,265 |
$0.00 |