| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,053 |
861 |
$1.42M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,994 |
3,221 |
$631K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,153 |
2,480 |
$433K |
| D4355 |
|
4,039 |
4,023 |
$290K |
| D2950 |
|
1,481 |
872 |
$259K |
| D1110 |
Prophylaxis - adult |
5,919 |
5,899 |
$236K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,298 |
2,542 |
$233K |
| D0140 |
Limited oral evaluation - problem focused |
8,379 |
8,200 |
$228K |
| D0210 |
Intraoral - complete series of radiographic images |
4,477 |
4,446 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
8,378 |
8,341 |
$207K |
| D1120 |
Prophylaxis - child |
4,796 |
4,793 |
$198K |
| D4341 |
|
1,228 |
449 |
$179K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,425 |
1,020 |
$175K |
| D0274 |
Bitewings - four radiographic images |
5,585 |
5,558 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,631 |
3,616 |
$126K |
| D1351 |
Sealant - per tooth |
3,786 |
852 |
$116K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,283 |
819 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
7,762 |
7,605 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,939 |
2,936 |
$72K |
| D1206 |
Topical application of fluoride varnish |
2,501 |
2,501 |
$68K |
| D2783 |
|
88 |
75 |
$62K |
| D3320 |
|
106 |
80 |
$50K |
| D0330 |
Panoramic radiographic image |
1,319 |
1,313 |
$42K |
| D7111 |
|
500 |
318 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,513 |
3,666 |
$33K |
| D3310 |
|
71 |
29 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,323 |
$29K |
| D2332 |
|
233 |
119 |
$29K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
28 |
$16K |
| D4910 |
|
160 |
160 |
$15K |
| D2330 |
|
148 |
74 |
$13K |
| D5226 |
|
14 |
14 |
$12K |
| D4342 |
|
99 |
29 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
12 |
$5K |
| D2331 |
|
59 |
43 |
$4K |
| D5110 |
|
12 |
12 |
$4K |
| D2335 |
|
24 |
16 |
$4K |
| D0270 |
|
326 |
326 |
$3K |
| D2394 |
|
19 |
16 |
$2K |