| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,949 |
1,326 |
$1.38M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
484 |
443 |
$340K |
| D1110 |
Prophylaxis - adult |
5,090 |
4,974 |
$277K |
| D2950 |
|
1,663 |
1,235 |
$268K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,865 |
1,017 |
$263K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,951 |
1,642 |
$251K |
| D0274 |
Bitewings - four radiographic images |
5,165 |
5,023 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,833 |
3,724 |
$165K |
| D3320 |
|
307 |
263 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,102 |
2,049 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
9,029 |
8,534 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,310 |
5,167 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,312 |
830 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,072 |
2,954 |
$118K |
| D1120 |
Prophylaxis - child |
2,328 |
2,265 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,753 |
896 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,868 |
6,049 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,265 |
3,168 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
600 |
333 |
$46K |
| D2394 |
|
310 |
187 |
$38K |
| D4341 |
|
349 |
124 |
$35K |
| D5212 |
|
43 |
43 |
$26K |
| D1351 |
Sealant - per tooth |
519 |
144 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
31 |
25 |
$16K |
| D5211 |
|
29 |
29 |
$15K |
| D0272 |
Bitewings - two radiographic images |
222 |
212 |
$6K |
| D2332 |
|
48 |
28 |
$6K |
| D0270 |
|
360 |
351 |
$5K |
| D2954 |
|
12 |
12 |
$2K |
| D2330 |
|
24 |
15 |
$1K |
| D3120 |
|
18 |
13 |
$690.00 |
| D1999 |
|
87 |
66 |
$0.00 |