| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,334 |
1,486 |
$1.64M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,664 |
1,858 |
$647K |
| D1110 |
Prophylaxis - adult |
8,384 |
8,334 |
$446K |
| D0274 |
Bitewings - four radiographic images |
9,475 |
9,416 |
$339K |
| D2950 |
|
1,551 |
1,035 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,884 |
1,945 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
8,157 |
8,126 |
$195K |
| D0330 |
Panoramic radiographic image |
3,697 |
3,637 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
3,951 |
3,818 |
$157K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
288 |
215 |
$156K |
| D8670 |
Periodic orthodontic treatment visit |
697 |
652 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,109 |
1,348 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,193 |
3,164 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
9,042 |
7,749 |
$128K |
| D1120 |
Prophylaxis - child |
2,251 |
2,235 |
$112K |
| D4341 |
|
1,425 |
493 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,544 |
3,529 |
$104K |
| D1351 |
Sealant - per tooth |
1,489 |
471 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
474 |
370 |
$46K |
| D2954 |
|
246 |
196 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,285 |
2,738 |
$43K |
| D9945 |
|
132 |
130 |
$39K |
| D3120 |
|
1,076 |
675 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
408 |
174 |
$33K |
| D9940 |
|
113 |
109 |
$33K |
| D4342 |
|
444 |
159 |
$33K |
| D2332 |
|
244 |
156 |
$29K |
| D3320 |
|
46 |
41 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
28 |
$20K |
| D0272 |
Bitewings - two radiographic images |
614 |
613 |
$18K |
| D2335 |
|
102 |
60 |
$15K |
| D2330 |
|
207 |
121 |
$15K |
| D2331 |
|
135 |
103 |
$13K |
| D9110 |
|
231 |
201 |
$10K |
| D9941 |
|
104 |
103 |
$9K |
| D5211 |
|
12 |
12 |
$6K |
| D8660 |
|
88 |
88 |
$6K |
| D7311 |
|
30 |
24 |
$3K |
| D2394 |
|
21 |
16 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |
| D8680 |
|
26 |
13 |
$2K |
| D9450 |
|
148 |
136 |
$0.00 |