| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,069 |
5,765 |
$796K |
| D2740 |
Crown - porcelain/ceramic |
1,641 |
1,202 |
$777K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,745 |
9,703 |
$636K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,583 |
4,250 |
$460K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,537 |
1,985 |
$413K |
| D1110 |
Prophylaxis - adult |
4,574 |
4,560 |
$398K |
| D0210 |
Intraoral - complete series of radiographic images |
8,120 |
8,089 |
$382K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,092 |
2,702 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
4,088 |
4,077 |
$315K |
| D1120 |
Prophylaxis - child |
5,502 |
5,478 |
$258K |
| D0350 |
|
22,451 |
7,339 |
$218K |
| D1206 |
Topical application of fluoride varnish |
10,383 |
10,338 |
$171K |
| D4341 |
|
2,304 |
613 |
$160K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,292 |
335 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,198 |
7,741 |
$137K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
287 |
257 |
$133K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,076 |
313 |
$105K |
| D1351 |
Sealant - per tooth |
2,889 |
787 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,468 |
629 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,117 |
3,106 |
$65K |
| D2330 |
|
821 |
510 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,114 |
4,807 |
$60K |
| D3320 |
|
161 |
134 |
$59K |
| D4910 |
|
712 |
707 |
$54K |
| D9430 |
|
1,577 |
1,540 |
$50K |
| D2331 |
|
621 |
402 |
$49K |
| D1310 |
|
592 |
592 |
$25K |
| D3310 |
|
72 |
37 |
$22K |
| D2332 |
|
187 |
134 |
$15K |
| D2954 |
|
133 |
96 |
$14K |
| D0330 |
Panoramic radiographic image |
370 |
368 |
$11K |
| D1510 |
|
47 |
27 |
$10K |
| D2335 |
|
68 |
41 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
180 |
$7K |
| D7230 |
|
39 |
17 |
$7K |
| D9248 |
|
134 |
134 |
$5K |
| D3221 |
|
67 |
54 |
$4K |
| D4342 |
|
42 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
144 |
144 |
$2K |
| D0603 |
|
87 |
87 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D9993 |
|
16 |
15 |
$975.00 |
| D0270 |
|
131 |
130 |
$630.00 |