| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,497 |
1,182 |
$710K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,251 |
7,238 |
$476K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
922 |
834 |
$424K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,840 |
1,147 |
$331K |
| D0210 |
Intraoral - complete series of radiographic images |
6,591 |
6,578 |
$312K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,403 |
1,549 |
$228K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,675 |
1,370 |
$200K |
| D0350 |
|
10,086 |
2,709 |
$97K |
| D1110 |
Prophylaxis - adult |
841 |
839 |
$73K |
| D2952 |
|
632 |
506 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
897 |
894 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
969 |
476 |
$64K |
| D9430 |
|
1,761 |
1,582 |
$55K |
| D3320 |
|
124 |
117 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,160 |
2,342 |
$42K |
| D1120 |
Prophylaxis - child |
860 |
859 |
$39K |
| D4341 |
|
512 |
135 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,266 |
2,264 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
229 |
$31K |
| D2140 |
|
440 |
246 |
$24K |
| D2954 |
|
222 |
188 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
1,025 |
$22K |
| D2335 |
|
178 |
71 |
$21K |
| D4910 |
|
253 |
253 |
$19K |
| D2160 |
|
180 |
123 |
$14K |
| D2332 |
|
87 |
49 |
$7K |
| D1351 |
Sealant - per tooth |
193 |
56 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
434 |
411 |
$5K |
| D0330 |
Panoramic radiographic image |
206 |
205 |
$4K |
| D2330 |
|
47 |
29 |
$4K |
| D2331 |
|
38 |
25 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
13 |
$2K |
| D2394 |
|
23 |
12 |
$2K |
| D9110 |
|
14 |
14 |
$819.00 |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$720.00 |