| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,344 |
1,001 |
$619K |
| D1110 |
Prophylaxis - adult |
6,009 |
5,856 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,485 |
1,365 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
7,148 |
6,944 |
$146K |
| D2954 |
|
935 |
721 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
2,053 |
2,029 |
$107K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,367 |
620 |
$102K |
| D1120 |
Prophylaxis - child |
2,863 |
2,796 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
119 |
106 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
8,181 |
7,837 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,631 |
2,507 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,748 |
2,663 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,776 |
2,722 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
642 |
379 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,472 |
1,467 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,599 |
5,839 |
$26K |
| D1351 |
Sealant - per tooth |
1,000 |
171 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
163 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,598 |
1,563 |
$18K |
| D0603 |
|
1,450 |
1,409 |
$13K |
| D9310 |
|
477 |
468 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
751 |
669 |
$9K |
| D0330 |
Panoramic radiographic image |
185 |
183 |
$7K |
| D3320 |
|
18 |
15 |
$7K |
| D4341 |
|
54 |
17 |
$5K |
| D0270 |
|
291 |
291 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
28 |
$2K |
| D4910 |
|
13 |
13 |
$832.00 |