| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,456 |
1,190 |
$1.41M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,995 |
4,398 |
$762K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,910 |
3,250 |
$593K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,137 |
3,332 |
$438K |
| D2950 |
|
2,648 |
1,442 |
$388K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,271 |
2,052 |
$358K |
| D0210 |
Intraoral - complete series of radiographic images |
7,232 |
7,133 |
$338K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,679 |
10,603 |
$338K |
| D1110 |
Prophylaxis - adult |
8,399 |
8,343 |
$305K |
| D3310 |
|
813 |
429 |
$302K |
| D3320 |
|
679 |
552 |
$292K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
417 |
396 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,952 |
1,737 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
8,656 |
8,614 |
$196K |
| D1120 |
Prophylaxis - child |
4,883 |
4,861 |
$195K |
| D0140 |
Limited oral evaluation - problem focused |
5,147 |
4,972 |
$155K |
| D0274 |
Bitewings - four radiographic images |
6,490 |
6,444 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,201 |
5,177 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
9,242 |
9,047 |
$101K |
| D4341 |
|
893 |
267 |
$91K |
| D2394 |
|
753 |
538 |
$82K |
| D5226 |
|
108 |
108 |
$67K |
| D2332 |
|
777 |
460 |
$64K |
| D5225 |
|
107 |
107 |
$61K |
| D5110 |
|
110 |
110 |
$60K |
| D2335 |
|
553 |
311 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,354 |
5,294 |
$49K |
| D7250 |
|
344 |
136 |
$45K |
| D4355 |
|
525 |
524 |
$27K |
| D2330 |
|
429 |
277 |
$26K |
| D1351 |
Sealant - per tooth |
615 |
95 |
$19K |
| D0330 |
Panoramic radiographic image |
720 |
713 |
$17K |
| D2331 |
|
184 |
142 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
117 |
59 |
$16K |
| D0272 |
Bitewings - two radiographic images |
604 |
603 |
$13K |
| D7230 |
|
98 |
74 |
$11K |
| D1206 |
Topical application of fluoride varnish |
240 |
240 |
$7K |
| D5120 |
|
12 |
12 |
$4K |
| D0270 |
|
349 |
344 |
$4K |
| D4342 |
|
51 |
16 |
$4K |
| D1354 |
|
69 |
21 |
$2K |
| D7310 |
|
20 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$1K |
| D1330 |
|
84 |
84 |
$0.00 |