| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
17,700 |
2,701 |
$512K |
| D2740 |
Crown - porcelain/ceramic |
810 |
579 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,203 |
2,350 |
$446K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,273 |
1,481 |
$351K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,492 |
1,469 |
$317K |
| D1110 |
Prophylaxis - adult |
7,197 |
7,079 |
$307K |
| D0120 |
Periodic oral evaluation - established patient |
11,632 |
11,514 |
$293K |
| D1120 |
Prophylaxis - child |
7,036 |
6,994 |
$276K |
| D0210 |
Intraoral - complete series of radiographic images |
3,680 |
3,522 |
$222K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
328 |
303 |
$172K |
| D0220 |
Intraoral - periapical first radiographic image |
10,955 |
10,688 |
$152K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,525 |
6,479 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
4,561 |
4,440 |
$148K |
| D0274 |
Bitewings - four radiographic images |
4,612 |
4,555 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,495 |
955 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,006 |
8,348 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,732 |
2,681 |
$91K |
| D0330 |
Panoramic radiographic image |
2,174 |
2,124 |
$90K |
| D2950 |
|
607 |
501 |
$84K |
| D2394 |
|
556 |
384 |
$79K |
| D0240 |
|
3,254 |
1,795 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
817 |
438 |
$59K |
| D4355 |
|
639 |
635 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,183 |
2,178 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,765 |
1,760 |
$47K |
| D4910 |
|
555 |
550 |
$46K |
| D3320 |
|
79 |
73 |
$33K |
| D4341 |
|
260 |
69 |
$31K |
| D2954 |
|
129 |
109 |
$22K |
| D2335 |
|
58 |
38 |
$8K |
| D2332 |
|
82 |
50 |
$7K |
| D2331 |
|
15 |
12 |
$1K |