| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,349 |
1,605 |
$249K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
186 |
167 |
$128K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,465 |
875 |
$122K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
206 |
135 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,239 |
760 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
364 |
143 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,373 |
1,354 |
$39K |
| D1110 |
Prophylaxis - adult |
902 |
894 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,674 |
1,663 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,339 |
1,329 |
$34K |
| D1120 |
Prophylaxis - child |
949 |
944 |
$33K |
| D0330 |
Panoramic radiographic image |
978 |
962 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,219 |
1,205 |
$32K |
| D2950 |
|
200 |
145 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,531 |
2,236 |
$24K |
| D3320 |
|
46 |
39 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
738 |
636 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
160 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
29 |
15 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
498 |
486 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,262 |
1,051 |
$10K |
| D2332 |
|
111 |
68 |
$8K |
| D2335 |
|
91 |
54 |
$7K |
| D0272 |
Bitewings - two radiographic images |
358 |
357 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
37 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
46 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
52 |
38 |
$5K |
| D2394 |
|
29 |
24 |
$2K |
| D2160 |
|
20 |
12 |
$2K |
| D0180 |
|
155 |
150 |
$0.00 |