| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,157 |
755 |
$641K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,692 |
1,964 |
$419K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,446 |
880 |
$206K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,433 |
549 |
$204K |
| D1110 |
Prophylaxis - adult |
4,086 |
4,083 |
$197K |
| D2950 |
|
1,013 |
694 |
$154K |
| D1120 |
Prophylaxis - child |
4,293 |
4,291 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
6,153 |
6,149 |
$152K |
| D1351 |
Sealant - per tooth |
4,867 |
1,040 |
$128K |
| D1206 |
Topical application of fluoride varnish |
7,254 |
7,241 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,444 |
987 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,584 |
2,580 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,232 |
3,229 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
5,634 |
5,538 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,211 |
1,206 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,363 |
1,318 |
$55K |
| D0330 |
Panoramic radiographic image |
1,058 |
1,057 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,080 |
4,431 |
$43K |
| D2331 |
|
427 |
257 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
384 |
135 |
$32K |
| D4341 |
|
192 |
83 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,042 |
1,041 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
28 |
$16K |
| D2332 |
|
82 |
54 |
$11K |
| D2330 |
|
64 |
40 |
$5K |
| D0180 |
|
25 |
25 |
$1K |
| D1354 |
|
32 |
15 |
$400.75 |
| D0431 |
|
1,059 |
1,046 |
$0.00 |