| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,477 |
2,454 |
$471K |
| D2740 |
Crown - porcelain/ceramic |
690 |
490 |
$452K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,174 |
1,995 |
$337K |
| D4910 |
|
2,474 |
2,401 |
$173K |
| D4341 |
|
824 |
329 |
$143K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
817 |
633 |
$135K |
| D1120 |
Prophylaxis - child |
3,702 |
3,677 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,139 |
694 |
$113K |
| D4342 |
|
1,169 |
466 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,501 |
3,481 |
$103K |
| D1206 |
Topical application of fluoride varnish |
5,333 |
5,296 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,461 |
2,457 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,698 |
3,665 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,554 |
4,505 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
6,204 |
6,123 |
$77K |
| D1110 |
Prophylaxis - adult |
1,734 |
1,722 |
$77K |
| D2950 |
|
438 |
386 |
$58K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
54 |
$51K |
| D0180 |
|
844 |
839 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
1,075 |
1,071 |
$29K |
| D0350 |
|
198 |
191 |
$23K |
| D0330 |
Panoramic radiographic image |
440 |
438 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
606 |
599 |
$20K |
| D3348 |
|
16 |
14 |
$20K |
| D0190 |
|
1,160 |
1,157 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
67 |
12 |
$13K |
| D0272 |
Bitewings - two radiographic images |
562 |
562 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
31 |
$9K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
81 |
12 |
$8K |
| D0380 |
|
48 |
48 |
$7K |
| D1351 |
Sealant - per tooth |
175 |
60 |
$6K |
| D2394 |
|
29 |
24 |
$6K |
| D9310 |
|
135 |
135 |
$6K |
| D0460 |
|
74 |
70 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$370.44 |