| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
4,996 |
3,134 |
$2.35M |
| D1110 |
Prophylaxis - adult |
14,536 |
14,468 |
$1.25M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,431 |
1,730 |
$1.15M |
| D4341 |
|
14,961 |
4,070 |
$1.04M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,217 |
12,182 |
$802K |
| D4910 |
|
9,632 |
9,559 |
$741K |
| D0120 |
Periodic oral evaluation - established patient |
9,168 |
9,112 |
$690K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,503 |
1,383 |
$687K |
| D0210 |
Intraoral - complete series of radiographic images |
10,707 |
10,674 |
$507K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,054 |
4,430 |
$468K |
| D2954 |
|
3,014 |
2,131 |
$312K |
| D3320 |
|
801 |
677 |
$289K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,038 |
2,717 |
$272K |
| D1120 |
Prophylaxis - child |
5,849 |
5,823 |
$256K |
| D0274 |
Bitewings - four radiographic images |
8,924 |
8,870 |
$189K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,842 |
12,781 |
$165K |
| D4342 |
|
3,780 |
1,320 |
$157K |
| D9430 |
|
4,837 |
4,610 |
$150K |
| D1206 |
Topical application of fluoride varnish |
7,508 |
7,469 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,510 |
11,790 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
10,899 |
9,915 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,599 |
823 |
$91K |
| D3310 |
|
301 |
199 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,015 |
768 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
682 |
537 |
$79K |
| D2330 |
|
401 |
235 |
$30K |
| D0350 |
|
6,122 |
3,001 |
$28K |
| D3221 |
|
135 |
102 |
$8K |
| D3348 |
|
14 |
12 |
$6K |
| D2920 |
|
37 |
34 |
$2K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$1K |
| D1351 |
Sealant - per tooth |
49 |
13 |
$896.50 |
| D0272 |
Bitewings - two radiographic images |
43 |
23 |
$200.00 |