| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,467 |
1,636 |
$1.69M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,030 |
2,414 |
$372K |
| D1110 |
Prophylaxis - adult |
5,756 |
5,458 |
$315K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,003 |
1,668 |
$217K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
283 |
259 |
$197K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,398 |
803 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,485 |
3,276 |
$152K |
| D0274 |
Bitewings - four radiographic images |
3,943 |
3,735 |
$140K |
| D2954 |
|
718 |
544 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
5,441 |
5,201 |
$133K |
| D1120 |
Prophylaxis - child |
2,444 |
2,328 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
2,927 |
2,743 |
$111K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
193 |
125 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
943 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,515 |
4,239 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,961 |
1,918 |
$57K |
| D0330 |
Panoramic radiographic image |
1,153 |
1,068 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
342 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,316 |
2,233 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,510 |
1,408 |
$35K |
| D3120 |
|
866 |
591 |
$31K |
| D2950 |
|
214 |
146 |
$28K |
| D1351 |
Sealant - per tooth |
293 |
81 |
$12K |
| D0272 |
Bitewings - two radiographic images |
402 |
386 |
$12K |
| D3320 |
|
13 |
12 |
$8K |
| D2332 |
|
22 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$2K |
| D2331 |
|
15 |
14 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$524.00 |
| D1330 |
|
12 |
12 |
$0.00 |