| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
817 |
628 |
$387K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,593 |
3,557 |
$229K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
291 |
253 |
$134K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,450 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
2,370 |
2,354 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
1,739 |
1,733 |
$101K |
| D1120 |
Prophylaxis - child |
1,634 |
1,621 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,241 |
3,713 |
$71K |
| D1351 |
Sealant - per tooth |
1,808 |
432 |
$67K |
| D0350 |
|
5,393 |
1,525 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,030 |
3,006 |
$47K |
| D9430 |
|
1,438 |
1,407 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
769 |
401 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
366 |
$37K |
| D2954 |
|
339 |
261 |
$35K |
| D0330 |
Panoramic radiographic image |
889 |
879 |
$26K |
| D3320 |
|
73 |
62 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,233 |
1,220 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,747 |
1,731 |
$21K |
| D4341 |
|
154 |
55 |
$11K |
| D4910 |
|
129 |
129 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
50 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
26 |
$5K |
| D0270 |
|
746 |
743 |
$4K |
| D1310 |
|
39 |
38 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
85 |
$796.00 |
| D1354 |
|
121 |
41 |
$756.00 |
| D0272 |
Bitewings - two radiographic images |
60 |
59 |
$580.00 |
| D1999 |
|
380 |
310 |
$92.00 |