| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
396 |
287 |
$195K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
223 |
195 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,645 |
857 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
893 |
222 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
873 |
565 |
$55K |
| D1110 |
Prophylaxis - adult |
1,304 |
1,287 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,212 |
2,172 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,462 |
1,253 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
481 |
340 |
$41K |
| D2950 |
|
689 |
508 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,511 |
1,485 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,148 |
1,129 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
542 |
530 |
$28K |
| D1120 |
Prophylaxis - child |
789 |
787 |
$27K |
| D0274 |
Bitewings - four radiographic images |
970 |
953 |
$23K |
| D0330 |
Panoramic radiographic image |
606 |
597 |
$22K |
| D1351 |
Sealant - per tooth |
693 |
184 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,968 |
1,908 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
749 |
728 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,322 |
1,247 |
$8K |
| D2331 |
|
103 |
74 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
26 |
$6K |
| D2991 |
|
129 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
210 |
208 |
$3K |
| D0431 |
|
15 |
15 |
$0.00 |