| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
317 |
201 |
$227K |
| D1110 |
Prophylaxis - adult |
3,366 |
3,329 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,395 |
2,355 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,477 |
1,435 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,137 |
634 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,279 |
3,261 |
$81K |
| D1120 |
Prophylaxis - child |
1,184 |
1,175 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
848 |
456 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,365 |
1,354 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,056 |
1,037 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,252 |
1,247 |
$38K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
49 |
43 |
$35K |
| D4342 |
|
248 |
93 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,281 |
1,255 |
$21K |
| D1351 |
Sealant - per tooth |
493 |
130 |
$18K |
| D2954 |
|
92 |
58 |
$17K |
| D7311 |
|
91 |
51 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
41 |
$10K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$5K |
| D4341 |
|
36 |
12 |
$4K |
| D2332 |
|
38 |
24 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
26 |
$3K |
| D1206 |
Topical application of fluoride varnish |
107 |
107 |
$3K |
| D0272 |
Bitewings - two radiographic images |
88 |
88 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
83 |
$1K |