| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,799 |
1,306 |
$844K |
| D1110 |
Prophylaxis - adult |
9,338 |
9,292 |
$391K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,164 |
3,012 |
$391K |
| D0120 |
Periodic oral evaluation - established patient |
16,305 |
16,209 |
$338K |
| D1120 |
Prophylaxis - child |
10,240 |
10,175 |
$275K |
| D8670 |
Periodic orthodontic treatment visit |
5,009 |
4,753 |
$269K |
| D2954 |
|
2,180 |
1,754 |
$250K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
376 |
359 |
$234K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,271 |
1,268 |
$217K |
| D0210 |
Intraoral - complete series of radiographic images |
3,163 |
3,139 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,312 |
11,249 |
$168K |
| D1351 |
Sealant - per tooth |
7,629 |
935 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
6,073 |
5,912 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
242 |
204 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,956 |
4,920 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,550 |
3,515 |
$84K |
| D0272 |
Bitewings - two radiographic images |
5,375 |
5,346 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,047 |
704 |
$59K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
570 |
379 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
7,099 |
6,971 |
$51K |
| D4341 |
|
527 |
205 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
794 |
463 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
292 |
$34K |
| D9310 |
|
1,490 |
1,468 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,404 |
2,204 |
$32K |
| D0330 |
Panoramic radiographic image |
498 |
481 |
$16K |
| D4910 |
|
278 |
267 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,298 |
2,204 |
$9K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$9K |
| D0270 |
|
1,119 |
1,109 |
$9K |
| D8660 |
|
186 |
185 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,084 |
1,074 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
101 |
69 |
$6K |
| D3320 |
|
15 |
14 |
$6K |
| D0601 |
|
252 |
252 |
$3K |
| D2331 |
|
12 |
12 |
$816.00 |
| D0350 |
|
261 |
237 |
$156.00 |