| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,084 |
685 |
$503K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,354 |
1,885 |
$222K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,481 |
1,453 |
$195K |
| D1110 |
Prophylaxis - adult |
1,622 |
1,618 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,967 |
1,962 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
1,524 |
1,517 |
$120K |
| D2954 |
|
922 |
614 |
$94K |
| D0350 |
|
8,995 |
2,876 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,692 |
1,687 |
$80K |
| D9430 |
|
2,214 |
2,062 |
$70K |
| D4910 |
|
854 |
839 |
$59K |
| D2394 |
|
671 |
471 |
$55K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
119 |
108 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,919 |
2,901 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,788 |
2,779 |
$42K |
| D1120 |
Prophylaxis - child |
921 |
917 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,404 |
$28K |
| D2335 |
|
211 |
90 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,592 |
1,504 |
$19K |
| D4341 |
|
264 |
71 |
$17K |
| D3320 |
|
43 |
38 |
$16K |
| D2331 |
|
180 |
129 |
$14K |
| D2332 |
|
141 |
80 |
$11K |
| D3221 |
|
179 |
138 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
73 |
$8K |
| D1320 |
|
331 |
331 |
$6K |
| D2330 |
|
50 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$2K |
| D9110 |
|
12 |
12 |
$693.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$525.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$144.00 |
| D1999 |
|
229 |
212 |
$10.00 |
| D1330 |
|
17 |
17 |
$0.00 |