| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,666 |
1,256 |
$786K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,328 |
5,276 |
$742K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,228 |
1,089 |
$564K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,160 |
8,115 |
$531K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,593 |
3,338 |
$434K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,991 |
1,646 |
$350K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,342 |
3,085 |
$340K |
| D0210 |
Intraoral - complete series of radiographic images |
6,798 |
6,766 |
$320K |
| D1110 |
Prophylaxis - adult |
3,309 |
3,291 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
2,557 |
2,541 |
$200K |
| D1120 |
Prophylaxis - child |
3,881 |
3,847 |
$189K |
| D0350 |
|
16,224 |
5,940 |
$157K |
| D4341 |
|
2,259 |
648 |
$157K |
| D3320 |
|
415 |
337 |
$149K |
| D1206 |
Topical application of fluoride varnish |
7,352 |
7,301 |
$120K |
| D1351 |
Sealant - per tooth |
2,466 |
700 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,147 |
4,465 |
$80K |
| D2330 |
|
1,051 |
580 |
$80K |
| D2394 |
|
724 |
569 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
954 |
431 |
$53K |
| D2332 |
|
585 |
358 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,077 |
2,065 |
$43K |
| D2335 |
|
332 |
182 |
$38K |
| D2954 |
|
345 |
244 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
272 |
45 |
$33K |
| D3310 |
|
80 |
53 |
$24K |
| D9430 |
|
750 |
732 |
$24K |
| D4910 |
|
292 |
292 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,721 |
1,677 |
$20K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
187 |
42 |
$18K |
| D0330 |
Panoramic radiographic image |
477 |
476 |
$13K |
| D3221 |
|
144 |
118 |
$9K |
| D2331 |
|
92 |
66 |
$7K |
| D1310 |
|
115 |
115 |
$5K |
| D5211 |
|
14 |
14 |
$5K |
| D4342 |
|
72 |
26 |
$3K |
| D9248 |
|
66 |
50 |
$2K |
| D0272 |
Bitewings - two radiographic images |
99 |
97 |
$1K |
| D0270 |
|
121 |
119 |
$595.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$254.00 |
| D0603 |
|
12 |
12 |
$180.00 |