| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,045 |
753 |
$699K |
| D1110 |
Prophylaxis - adult |
13,303 |
12,363 |
$679K |
| D0274 |
Bitewings - four radiographic images |
12,085 |
11,261 |
$425K |
| D1120 |
Prophylaxis - child |
8,532 |
7,991 |
$412K |
| D0120 |
Periodic oral evaluation - established patient |
14,792 |
13,850 |
$353K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,787 |
7,200 |
$333K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
458 |
397 |
$296K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,666 |
2,329 |
$286K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,137 |
9,470 |
$281K |
| D1351 |
Sealant - per tooth |
6,864 |
1,612 |
$255K |
| D0220 |
Intraoral - periapical first radiographic image |
15,821 |
14,454 |
$245K |
| D0140 |
Limited oral evaluation - problem focused |
6,540 |
6,007 |
$241K |
| D0210 |
Intraoral - complete series of radiographic images |
3,560 |
3,315 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,208 |
1,703 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,828 |
2,145 |
$228K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,193 |
10,044 |
$155K |
| D2950 |
|
985 |
756 |
$149K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
818 |
543 |
$111K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
148 |
114 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
852 |
574 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,546 |
2,410 |
$72K |
| D2335 |
|
514 |
306 |
$61K |
| D3320 |
|
109 |
95 |
$57K |
| D2954 |
|
235 |
178 |
$43K |
| D2332 |
|
328 |
215 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
406 |
267 |
$30K |
| D2330 |
|
329 |
176 |
$21K |
| D2331 |
|
219 |
118 |
$16K |
| D1206 |
Topical application of fluoride varnish |
584 |
555 |
$14K |
| D4341 |
|
107 |
39 |
$10K |
| D2394 |
|
94 |
77 |
$10K |
| D3310 |
|
18 |
12 |
$9K |
| D2140 |
|
92 |
53 |
$5K |
| D0270 |
|
176 |
169 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$252.00 |
| D1999 |
|
14,656 |
12,192 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |