| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,911 |
1,017 |
$1.02M |
| D1351 |
Sealant - per tooth |
11,719 |
1,366 |
$333K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,334 |
1,559 |
$276K |
| D1110 |
Prophylaxis - adult |
4,879 |
4,859 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,794 |
3,780 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,705 |
1,083 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
3,637 |
3,452 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,041 |
5,027 |
$130K |
| D1120 |
Prophylaxis - child |
3,087 |
3,087 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
2,072 |
2,033 |
$125K |
| D4341 |
|
1,013 |
355 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
8,260 |
7,323 |
$118K |
| D2950 |
|
817 |
659 |
$116K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
740 |
494 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,339 |
3,328 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,000 |
712 |
$91K |
| D2790 |
|
136 |
123 |
$88K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
135 |
132 |
$71K |
| D4355 |
|
702 |
691 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,377 |
2,376 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,377 |
3,933 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,808 |
1,807 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
291 |
239 |
$40K |
| D3320 |
|
61 |
59 |
$26K |
| D2710 |
|
33 |
14 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
77 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
93 |
75 |
$11K |
| D0272 |
Bitewings - two radiographic images |
294 |
293 |
$7K |
| D3310 |
|
19 |
13 |
$6K |
| D0330 |
Panoramic radiographic image |
69 |
68 |
$4K |
| D7250 |
|
17 |
12 |
$3K |
| D4342 |
|
28 |
12 |
$2K |
| D4910 |
|
29 |
29 |
$2K |