| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,775 |
975 |
$360K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,089 |
679 |
$207K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
538 |
478 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,594 |
1,366 |
$142K |
| D2332 |
|
1,614 |
602 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,967 |
1,077 |
$93K |
| D2952 |
|
944 |
607 |
$78K |
| D3320 |
|
387 |
325 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
2,008 |
1,750 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
873 |
603 |
$58K |
| D3310 |
|
296 |
176 |
$47K |
| D9630 |
|
2,948 |
2,869 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,245 |
2,192 |
$36K |
| D1120 |
Prophylaxis - child |
1,732 |
1,718 |
$33K |
| D1110 |
Prophylaxis - adult |
1,068 |
1,042 |
$31K |
| D4355 |
|
512 |
487 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,905 |
1,811 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
2,283 |
2,249 |
$26K |
| D1206 |
Topical application of fluoride varnish |
2,002 |
1,988 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,749 |
3,444 |
$25K |
| D9920 |
|
434 |
428 |
$21K |
| D0330 |
Panoramic radiographic image |
337 |
332 |
$20K |
| D9994 |
|
3,662 |
3,579 |
$19K |
| D2331 |
|
160 |
65 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,764 |
1,970 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
84 |
$17K |
| D4341 |
|
1,099 |
308 |
$15K |
| D0274 |
Bitewings - four radiographic images |
658 |
648 |
$12K |
| D4342 |
|
208 |
53 |
$10K |
| D2330 |
|
227 |
143 |
$8K |
| D0272 |
Bitewings - two radiographic images |
592 |
587 |
$7K |
| D2335 |
|
59 |
40 |
$7K |
| D1351 |
Sealant - per tooth |
468 |
134 |
$3K |
| D3120 |
|
239 |
168 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
233 |
230 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
165 |
$2K |
| D4910 |
|
34 |
34 |
$0.00 |
| D2950 |
|
410 |
226 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$0.00 |
| D2954 |
|
17 |
14 |
$0.00 |
| D2394 |
|
31 |
26 |
$0.00 |
| D9310 |
|
29 |
29 |
$0.00 |