| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,490 |
1,098 |
$696K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,660 |
2,428 |
$353K |
| D1110 |
Prophylaxis - adult |
6,130 |
6,085 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
11,070 |
11,003 |
$226K |
| D1120 |
Prophylaxis - child |
6,481 |
6,431 |
$169K |
| D8670 |
Periodic orthodontic treatment visit |
2,796 |
2,678 |
$166K |
| D1351 |
Sealant - per tooth |
7,381 |
1,143 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
2,356 |
2,346 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,696 |
7,627 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,350 |
557 |
$113K |
| D2954 |
|
926 |
739 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
3,646 |
3,597 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,689 |
3,669 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,519 |
2,488 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
7,751 |
7,602 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
471 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
352 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,711 |
2,699 |
$34K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
46 |
$30K |
| D4341 |
|
299 |
115 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,670 |
1,488 |
$22K |
| D0330 |
Panoramic radiographic image |
555 |
543 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
422 |
222 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
218 |
138 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,902 |
4,387 |
$19K |
| D9310 |
|
695 |
692 |
$16K |
| D0603 |
|
1,188 |
1,178 |
$12K |
| D4910 |
|
176 |
176 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
85 |
$7K |
| D7111 |
|
107 |
54 |
$6K |
| D2335 |
|
58 |
43 |
$6K |
| D2331 |
|
73 |
38 |
$5K |
| D2332 |
|
34 |
26 |
$3K |
| D0602 |
|
205 |
205 |
$2K |
| D1206 |
Topical application of fluoride varnish |
197 |
197 |
$1K |
| D0270 |
|
129 |
129 |
$952.00 |
| D0601 |
|
82 |
82 |
$820.00 |
| D0350 |
|
52 |
50 |
$37.00 |