| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
901 |
626 |
$425K |
| D0120 |
Periodic oral evaluation - established patient |
4,469 |
4,450 |
$242K |
| D1110 |
Prophylaxis - adult |
2,629 |
2,622 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,939 |
2,928 |
$184K |
| D4341 |
|
2,418 |
883 |
$166K |
| D1120 |
Prophylaxis - child |
3,858 |
3,838 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,693 |
7,114 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,869 |
2,858 |
$134K |
| D9430 |
|
3,130 |
2,927 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,003 |
3,989 |
$83K |
| D2954 |
|
657 |
490 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,985 |
4,977 |
$59K |
| D4910 |
|
646 |
644 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
335 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
249 |
135 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
360 |
203 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
47 |
42 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,555 |
1,528 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,121 |
1,113 |
$13K |
| D0330 |
Panoramic radiographic image |
380 |
375 |
$10K |
| D1206 |
Topical application of fluoride varnish |
465 |
455 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
63 |
$7K |
| D2140 |
|
118 |
78 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
66 |
$6K |
| D3320 |
|
15 |
14 |
$5K |
| D2160 |
|
62 |
49 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
113 |
$4K |
| D4342 |
|
96 |
41 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
39 |
$4K |
| D1310 |
|
198 |
190 |
$2K |
| D0603 |
|
117 |
110 |
$825.00 |
| D0350 |
|
83 |
58 |
$768.00 |
| D1351 |
Sealant - per tooth |
33 |
12 |
$704.00 |
| D0270 |
|
13 |
13 |
$65.00 |
| D1999 |
|
174 |
153 |
$0.00 |