| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,477 |
1,896 |
$2.31M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,785 |
1,547 |
$1.20M |
| D1110 |
Prophylaxis - adult |
8,626 |
8,183 |
$429K |
| D2950 |
|
2,120 |
1,687 |
$321K |
| D0274 |
Bitewings - four radiographic images |
8,941 |
8,451 |
$300K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
479 |
255 |
$251K |
| D0220 |
Intraoral - periapical first radiographic image |
14,489 |
13,517 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
5,225 |
4,861 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
7,584 |
7,237 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,384 |
3,169 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,286 |
9,768 |
$126K |
| D2954 |
|
523 |
366 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,304 |
2,232 |
$65K |
| D1120 |
Prophylaxis - child |
1,303 |
1,265 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
621 |
310 |
$51K |
| D3320 |
|
81 |
74 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
167 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
90 |
$20K |
| D1351 |
Sealant - per tooth |
394 |
87 |
$16K |
| D0330 |
Panoramic radiographic image |
357 |
318 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
164 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
24 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
14 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
82 |
80 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
60 |
$2K |
| D9986 |
|
43 |
43 |
$0.00 |