| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
946 |
635 |
$528K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,763 |
1,613 |
$309K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,419 |
1,239 |
$209K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
242 |
233 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,167 |
3,158 |
$130K |
| D2950 |
|
801 |
636 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
837 |
626 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
2,019 |
1,817 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,210 |
802 |
$97K |
| D1110 |
Prophylaxis - adult |
1,798 |
1,797 |
$89K |
| D4341 |
|
649 |
245 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,075 |
2,013 |
$81K |
| D1120 |
Prophylaxis - child |
1,868 |
1,864 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,536 |
3,359 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,934 |
1,930 |
$44K |
| D0330 |
Panoramic radiographic image |
1,131 |
1,124 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,833 |
2,145 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,933 |
1,926 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,348 |
1,348 |
$37K |
| D3320 |
|
97 |
83 |
$35K |
| D1351 |
Sealant - per tooth |
410 |
101 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
101 |
57 |
$12K |
| D4342 |
|
152 |
63 |
$11K |
| D2790 |
|
14 |
12 |
$9K |
| D7111 |
|
128 |
89 |
$9K |
| D2954 |
|
45 |
36 |
$9K |
| D2330 |
|
123 |
73 |
$8K |
| D0272 |
Bitewings - two radiographic images |
317 |
317 |
$6K |
| D2332 |
|
50 |
38 |
$5K |
| D2394 |
|
30 |
27 |
$5K |
| D0270 |
|
218 |
215 |
$2K |
| D4346 |
|
28 |
28 |
$2K |
| D0180 |
|
42 |
42 |
$1K |
| D2331 |
|
18 |
12 |
$920.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
31 |
$703.75 |
| D9986 |
|
27 |
24 |
$0.00 |