| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,403 |
912 |
$686K |
| D1110 |
Prophylaxis - adult |
5,816 |
5,678 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,615 |
1,727 |
$187K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
310 |
280 |
$175K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,776 |
1,091 |
$148K |
| D2950 |
|
1,195 |
858 |
$141K |
| D1206 |
Topical application of fluoride varnish |
6,648 |
6,509 |
$137K |
| D0274 |
Bitewings - four radiographic images |
4,684 |
4,562 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,924 |
3,833 |
$92K |
| D7240 |
Removal of impacted tooth - completely bony |
288 |
90 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,930 |
3,624 |
$63K |
| D0330 |
Panoramic radiographic image |
1,923 |
1,868 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,675 |
4,518 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,791 |
1,747 |
$49K |
| D1120 |
Prophylaxis - child |
1,064 |
1,039 |
$34K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
264 |
209 |
$24K |
| D9222 |
|
241 |
238 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
875 |
849 |
$19K |
| D7230 |
|
59 |
27 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
408 |
388 |
$8K |
| D3310 |
|
19 |
12 |
$7K |
| D3320 |
|
13 |
12 |
$6K |
| D9610 |
|
256 |
251 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
68 |
$5K |
| D2335 |
|
54 |
26 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
73 |
$3K |
| D2332 |
|
38 |
29 |
$3K |
| D2394 |
|
34 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
94 |
27 |
$3K |
| D4342 |
|
49 |
12 |
$2K |
| D9612 |
|
13 |
13 |
$658.97 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$215.49 |