| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,773 |
2,251 |
$1.30M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,405 |
11,704 |
$1.21M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,349 |
14,293 |
$914K |
| D0120 |
Periodic oral evaluation - established patient |
12,268 |
12,192 |
$764K |
| D4341 |
|
8,503 |
2,902 |
$583K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,914 |
7,113 |
$578K |
| D0210 |
Intraoral - complete series of radiographic images |
12,278 |
12,231 |
$571K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,766 |
3,221 |
$551K |
| D1110 |
Prophylaxis - adult |
6,125 |
6,106 |
$509K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,537 |
4,175 |
$431K |
| D1120 |
Prophylaxis - child |
10,585 |
10,512 |
$430K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64,930 |
17,265 |
$333K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
572 |
555 |
$260K |
| D0274 |
Bitewings - four radiographic images |
10,759 |
10,699 |
$223K |
| D9430 |
|
7,017 |
6,695 |
$221K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,708 |
16,609 |
$210K |
| D0350 |
|
18,295 |
9,536 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,249 |
1,687 |
$182K |
| D4910 |
|
2,299 |
2,291 |
$173K |
| D2330 |
|
1,790 |
1,041 |
$135K |
| D2954 |
|
1,273 |
1,107 |
$132K |
| D1351 |
Sealant - per tooth |
4,199 |
1,226 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
6,488 |
6,234 |
$76K |
| D0330 |
Panoramic radiographic image |
1,607 |
1,598 |
$47K |
| D7230 |
|
210 |
194 |
$39K |
| D2331 |
|
490 |
313 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,875 |
1,861 |
$22K |
| D3320 |
|
56 |
52 |
$20K |
| D4342 |
|
254 |
93 |
$11K |
| D2332 |
|
55 |
41 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
106 |
85 |
$4K |
| D0270 |
|
355 |
342 |
$2K |
| D1206 |
Topical application of fluoride varnish |
96 |
96 |
$1K |
| D3221 |
|
13 |
13 |
$819.00 |
| D1999 |
|
16 |
16 |
$0.00 |