| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,497 |
1,892 |
$1.11M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,049 |
959 |
$567K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,865 |
2,777 |
$446K |
| D2954 |
|
2,570 |
1,977 |
$274K |
| D1110 |
Prophylaxis - adult |
6,710 |
6,530 |
$256K |
| D0210 |
Intraoral - complete series of radiographic images |
4,540 |
4,527 |
$235K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,250 |
2,137 |
$235K |
| D3320 |
|
434 |
374 |
$201K |
| D1120 |
Prophylaxis - child |
7,856 |
7,729 |
$199K |
| D1351 |
Sealant - per tooth |
10,107 |
1,699 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
9,821 |
9,632 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,098 |
1,518 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,531 |
9,447 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
6,500 |
6,311 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,253 |
5,054 |
$111K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,174 |
829 |
$105K |
| D4341 |
|
986 |
344 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,681 |
883 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
11,709 |
10,707 |
$66K |
| D0274 |
Bitewings - four radiographic images |
4,617 |
4,413 |
$65K |
| D0330 |
Panoramic radiographic image |
2,695 |
2,521 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,994 |
2,635 |
$37K |
| D4910 |
|
571 |
564 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
541 |
411 |
$32K |
| D2332 |
|
373 |
216 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,593 |
2,527 |
$29K |
| D9310 |
|
1,210 |
1,180 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,313 |
5,722 |
$21K |
| D2394 |
|
182 |
158 |
$19K |
| D1353 |
|
1,303 |
303 |
$13K |
| D4355 |
|
275 |
252 |
$11K |
| D7230 |
|
50 |
24 |
$9K |
| D0603 |
|
680 |
652 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
83 |
$6K |
| D1206 |
Topical application of fluoride varnish |
653 |
643 |
$6K |
| D2335 |
|
56 |
43 |
$6K |
| D3310 |
|
19 |
13 |
$5K |
| D0601 |
|
267 |
262 |
$2K |
| D0270 |
|
218 |
209 |
$1K |
| D0602 |
|
49 |
49 |
$430.00 |
| D0350 |
|
60 |
53 |
$50.00 |