| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
756 |
535 |
$327K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,298 |
1,281 |
$170K |
| D0210 |
Intraoral - complete series of radiographic images |
2,829 |
2,747 |
$145K |
| D1110 |
Prophylaxis - adult |
3,530 |
3,423 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,705 |
6,496 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
4,586 |
4,465 |
$90K |
| D4341 |
|
1,065 |
314 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
721 |
246 |
$64K |
| D1120 |
Prophylaxis - child |
2,504 |
2,461 |
$62K |
| D2954 |
|
514 |
410 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
617 |
396 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,245 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
917 |
537 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,465 |
2,368 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,950 |
1,896 |
$38K |
| D4355 |
|
790 |
748 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,148 |
3,966 |
$29K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
37 |
$25K |
| D4910 |
|
558 |
472 |
$21K |
| D0330 |
Panoramic radiographic image |
381 |
358 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,922 |
2,604 |
$12K |
| D1351 |
Sealant - per tooth |
535 |
78 |
$10K |
| D0272 |
Bitewings - two radiographic images |
444 |
444 |
$6K |
| D2950 |
|
104 |
72 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
14 |
$3K |
| D4346 |
|
74 |
68 |
$2K |
| D2335 |
|
22 |
15 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
113 |
109 |
$1K |
| D2331 |
|
16 |
14 |
$1K |
| D0180 |
|
41 |
40 |
$924.25 |
| D0270 |
|
20 |
20 |
$160.00 |
| D0350 |
|
87 |
87 |
$137.00 |