| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,096 |
809 |
$435K |
| D0120 |
Periodic oral evaluation - established patient |
15,092 |
14,885 |
$279K |
| D1110 |
Prophylaxis - adult |
13,233 |
13,057 |
$262K |
| D1120 |
Prophylaxis - child |
7,844 |
7,752 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,411 |
2,608 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
4,347 |
4,315 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,663 |
6,584 |
$114K |
| D1206 |
Topical application of fluoride varnish |
8,485 |
8,381 |
$104K |
| D1351 |
Sealant - per tooth |
6,627 |
774 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,360 |
1,420 |
$70K |
| D2954 |
|
829 |
617 |
$69K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
192 |
161 |
$67K |
| D0330 |
Panoramic radiographic image |
6,253 |
6,157 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,599 |
5,486 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
2,150 |
2,067 |
$37K |
| D0274 |
Bitewings - four radiographic images |
5,429 |
5,275 |
$36K |
| D4341 |
|
858 |
334 |
$27K |
| D0272 |
Bitewings - two radiographic images |
5,368 |
5,335 |
$26K |
| D3320 |
|
74 |
65 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
270 |
$21K |
| D0603 |
|
2,737 |
2,733 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
342 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
4,921 |
4,652 |
$15K |
| D2950 |
|
279 |
220 |
$14K |
| D4346 |
|
357 |
348 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,211 |
3,542 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
279 |
158 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
17 |
$10K |
| D0602 |
|
688 |
687 |
$4K |
| D0601 |
|
520 |
517 |
$3K |
| D9920 |
|
163 |
159 |
$2K |
| D1352 |
|
69 |
17 |
$690.00 |
| D9110 |
|
57 |
52 |
$550.00 |
| D8660 |
|
50 |
45 |
$445.00 |
| D0190 |
|
34 |
34 |
$165.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
16 |
$114.75 |
| D0270 |
|
31 |
17 |
$21.00 |
| D1999 |
|
53 |
49 |
$0.00 |