| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
10,121 |
6,211 |
$6.32M |
| D1110 |
Prophylaxis - adult |
64,461 |
63,453 |
$3.20M |
| D0274 |
Bitewings - four radiographic images |
51,464 |
50,517 |
$1.50M |
| D0330 |
Panoramic radiographic image |
30,350 |
29,558 |
$1.37M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,801 |
4,219 |
$1.26M |
| D2950 |
|
8,495 |
5,766 |
$1.25M |
| D0120 |
Periodic oral evaluation - established patient |
56,150 |
55,290 |
$1.19M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,162 |
1,010 |
$811K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,691 |
18,328 |
$710K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,495 |
4,209 |
$481K |
| D0140 |
Limited oral evaluation - problem focused |
13,017 |
12,562 |
$452K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,762 |
16,590 |
$430K |
| D0220 |
Intraoral - periapical first radiographic image |
34,390 |
32,867 |
$373K |
| D3320 |
|
534 |
419 |
$281K |
| D1120 |
Prophylaxis - child |
5,914 |
5,880 |
$275K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
469 |
320 |
$249K |
| D8670 |
Periodic orthodontic treatment visit |
1,153 |
1,114 |
$226K |
| D9450 |
|
10,565 |
8,539 |
$213K |
| D4341 |
|
1,699 |
691 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,693 |
947 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,796 |
1,696 |
$164K |
| D5110 |
|
285 |
276 |
$146K |
| D4910 |
|
2,433 |
2,379 |
$144K |
| D3310 |
|
315 |
172 |
$142K |
| D5212 |
|
249 |
246 |
$131K |
| D6740 |
|
302 |
121 |
$91K |
| D5211 |
|
178 |
176 |
$90K |
| D1206 |
Topical application of fluoride varnish |
4,105 |
4,008 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
846 |
637 |
$72K |
| D1351 |
Sealant - per tooth |
1,808 |
428 |
$69K |
| D6245 |
|
206 |
121 |
$63K |
| D1330 |
|
5,271 |
5,145 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,885 |
4,924 |
$56K |
| D5214 |
|
54 |
53 |
$47K |
| D5120 |
|
81 |
81 |
$36K |
| D2954 |
|
186 |
115 |
$30K |
| D4342 |
|
362 |
144 |
$27K |
| D5213 |
|
17 |
14 |
$13K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
12 |
$13K |
| D4381 |
|
356 |
103 |
$7K |
| D2331 |
|
69 |
54 |
$6K |
| D2335 |
|
46 |
24 |
$6K |
| D0272 |
Bitewings - two radiographic images |
261 |
261 |
$6K |
| D2332 |
|
49 |
32 |
$5K |
| D8660 |
|
181 |
169 |
$5K |
| D9243 |
|
43 |
12 |
$3K |
| D2330 |
|
58 |
24 |
$3K |
| D9110 |
|
78 |
75 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D3120 |
|
38 |
29 |
$1K |
| D4346 |
|
16 |
16 |
$728.00 |
| D0180 |
|
12 |
12 |
$391.00 |
| D9995 |
|
123 |
98 |
$0.00 |
| D1999 |
|
178 |
164 |
$0.00 |
| D0431 |
|
12 |
12 |
$0.00 |