| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
942 |
537 |
$637K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,417 |
2,159 |
$520K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,490 |
1,260 |
$225K |
| D1110 |
Prophylaxis - adult |
3,373 |
3,368 |
$169K |
| D2950 |
|
963 |
583 |
$167K |
| D1120 |
Prophylaxis - child |
3,661 |
3,655 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
5,310 |
5,305 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
857 |
561 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
2,171 |
1,932 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,765 |
2,760 |
$115K |
| D1206 |
Topical application of fluoride varnish |
3,857 |
3,853 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
4,545 |
4,393 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,765 |
1,764 |
$55K |
| D1351 |
Sealant - per tooth |
1,864 |
233 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
985 |
967 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
221 |
110 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
460 |
210 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,918 |
3,270 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
36 |
31 |
$23K |
| D4341 |
|
129 |
47 |
$20K |
| D0272 |
Bitewings - two radiographic images |
814 |
813 |
$18K |
| D0330 |
Panoramic radiographic image |
291 |
291 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
356 |
356 |
$8K |
| D4346 |
|
86 |
86 |
$6K |
| D1352 |
|
36 |
12 |
$3K |
| D4910 |
|
14 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
143 |
$0.00 |