| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
650 |
307 |
$416K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,875 |
1,719 |
$389K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,052 |
1,423 |
$311K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,235 |
1,174 |
$265K |
| D1110 |
Prophylaxis - adult |
2,162 |
2,146 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,899 |
1,845 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,054 |
378 |
$80K |
| D2394 |
|
536 |
295 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,936 |
1,905 |
$58K |
| D2954 |
|
253 |
165 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,262 |
1,204 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,871 |
1,861 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,509 |
2,327 |
$36K |
| D0274 |
Bitewings - four radiographic images |
961 |
953 |
$29K |
| D2950 |
|
182 |
84 |
$27K |
| D4355 |
|
456 |
450 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
24 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,348 |
1,343 |
$18K |
| D1351 |
Sealant - per tooth |
555 |
108 |
$17K |
| D1120 |
Prophylaxis - child |
390 |
390 |
$15K |
| D2330 |
|
125 |
66 |
$9K |
| D1206 |
Topical application of fluoride varnish |
316 |
316 |
$8K |
| D3320 |
|
18 |
13 |
$8K |
| D4341 |
|
52 |
28 |
$7K |
| D2335 |
|
66 |
27 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
204 |
204 |
$5K |
| D2332 |
|
27 |
12 |
$3K |
| D1999 |
|
17 |
17 |
$0.00 |