| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,603 |
920 |
$539K |
| D2750 |
|
1,083 |
714 |
$271K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,446 |
823 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,936 |
902 |
$128K |
| D1110 |
Prophylaxis - adult |
5,204 |
5,019 |
$124K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
403 |
363 |
$117K |
| D2332 |
|
2,415 |
428 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,403 |
4,247 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
3,382 |
3,262 |
$99K |
| D3320 |
|
473 |
377 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,720 |
845 |
$89K |
| D2950 |
|
1,700 |
988 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,053 |
2,981 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,146 |
4,971 |
$62K |
| D3310 |
|
332 |
207 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
2,377 |
2,155 |
$50K |
| D2954 |
|
1,077 |
709 |
$46K |
| D1120 |
Prophylaxis - child |
2,219 |
2,155 |
$44K |
| D2331 |
|
807 |
275 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,079 |
2,027 |
$34K |
| D0274 |
Bitewings - four radiographic images |
3,610 |
3,490 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
767 |
388 |
$27K |
| D4341 |
|
778 |
202 |
$27K |
| D1351 |
Sealant - per tooth |
2,547 |
318 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
5,082 |
4,606 |
$20K |
| D5225 |
|
44 |
42 |
$18K |
| D2161 |
|
333 |
68 |
$17K |
| D5226 |
|
31 |
29 |
$13K |
| D2335 |
|
187 |
22 |
$11K |
| D5214 |
|
26 |
26 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,219 |
3,118 |
$9K |
| D2394 |
|
122 |
38 |
$6K |
| D5213 |
|
15 |
15 |
$6K |
| D5760 |
|
48 |
48 |
$6K |
| D5761 |
|
32 |
32 |
$4K |
| D0170 |
|
129 |
124 |
$3K |
| D0272 |
Bitewings - two radiographic images |
588 |
570 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
91 |
$2K |
| D5421 |
|
92 |
90 |
$982.00 |
| D5422 |
|
65 |
64 |
$747.00 |
| D0190 |
|
189 |
186 |
$660.00 |
| D9110 |
|
54 |
52 |
$620.00 |
| D9920 |
|
14 |
14 |
$350.00 |
| D0171 |
|
17 |
15 |
$265.00 |
| D0603 |
|
25 |
25 |
$220.00 |