| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,093 |
1,299 |
$992K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,010 |
5,056 |
$796K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,054 |
3,433 |
$558K |
| D0120 |
Periodic oral evaluation - established patient |
7,420 |
7,336 |
$442K |
| D1110 |
Prophylaxis - adult |
4,023 |
3,992 |
$342K |
| D1120 |
Prophylaxis - child |
6,529 |
6,454 |
$249K |
| D4910 |
|
3,241 |
3,232 |
$248K |
| D2330 |
|
3,197 |
1,881 |
$243K |
| D4341 |
|
3,277 |
978 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,265 |
3,246 |
$205K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,642 |
2,207 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
40,546 |
8,578 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
3,638 |
3,619 |
$168K |
| D1206 |
Topical application of fluoride varnish |
10,369 |
10,312 |
$151K |
| D2394 |
|
1,793 |
1,243 |
$149K |
| D0350 |
|
17,553 |
5,144 |
$146K |
| D9430 |
|
3,416 |
3,015 |
$105K |
| D1351 |
Sealant - per tooth |
3,672 |
1,242 |
$98K |
| D0274 |
Bitewings - four radiographic images |
4,361 |
4,349 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,164 |
2,025 |
$85K |
| D1320 |
|
6,770 |
6,733 |
$80K |
| D2954 |
|
697 |
543 |
$73K |
| D2940 |
|
1,218 |
971 |
$65K |
| D1310 |
|
1,451 |
1,435 |
$64K |
| D0330 |
Panoramic radiographic image |
2,064 |
2,052 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
513 |
255 |
$58K |
| D4342 |
|
1,351 |
473 |
$56K |
| D9993 |
|
711 |
707 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,304 |
2,202 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
50 |
$26K |
| D4260 |
|
44 |
15 |
$22K |
| D2931 |
|
125 |
107 |
$16K |
| D0603 |
|
1,063 |
1,050 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
65 |
25 |
$15K |
| D9110 |
|
245 |
237 |
$15K |
| D3320 |
|
38 |
30 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
195 |
194 |
$10K |
| D1354 |
|
635 |
173 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
59 |
$7K |
| D2932 |
|
64 |
49 |
$7K |
| D3221 |
|
64 |
55 |
$4K |
| D0270 |
|
698 |
666 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
198 |
$2K |
| D2331 |
|
31 |
27 |
$2K |
| D9910 |
|
52 |
45 |
$2K |
| D2332 |
|
22 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
108 |
$2K |
| D5850 |
|
15 |
13 |
$980.00 |
| D9995 |
|
1,256 |
1,155 |
$340.16 |
| D1999 |
|
156 |
156 |
$46.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
91 |
87 |
$0.96 |