| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
637 |
339 |
$408K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,801 |
2,187 |
$232K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,502 |
7,213 |
$210K |
| D1110 |
Prophylaxis - adult |
5,381 |
5,187 |
$202K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,098 |
1,953 |
$179K |
| D0274 |
Bitewings - four radiographic images |
8,341 |
8,015 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,255 |
1,176 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
8,616 |
8,326 |
$169K |
| D0330 |
Panoramic radiographic image |
2,847 |
2,741 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,786 |
909 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
4,777 |
4,375 |
$117K |
| D2140 |
|
2,662 |
1,509 |
$106K |
| D1120 |
Prophylaxis - child |
4,673 |
4,561 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,182 |
765 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,742 |
5,602 |
$98K |
| D2331 |
|
1,213 |
719 |
$88K |
| D2332 |
|
819 |
474 |
$72K |
| D2160 |
|
1,060 |
774 |
$71K |
| D0240 |
|
5,071 |
2,267 |
$67K |
| D2752 |
|
160 |
69 |
$67K |
| D2330 |
|
1,131 |
665 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,792 |
4,548 |
$59K |
| D1351 |
Sealant - per tooth |
1,469 |
349 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
8,697 |
8,120 |
$48K |
| D2931 |
|
312 |
249 |
$43K |
| D2950 |
|
347 |
235 |
$37K |
| D3310 |
|
95 |
61 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,063 |
2,983 |
$35K |
| D9944 |
|
91 |
89 |
$21K |
| D2952 |
|
130 |
54 |
$17K |
| D3320 |
|
27 |
26 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
208 |
$12K |
| D1320 |
|
692 |
659 |
$11K |
| D2954 |
|
48 |
39 |
$9K |
| D2335 |
|
107 |
71 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
72 |
$4K |
| D2161 |
|
16 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
21 |
$1K |
| D0180 |
|
29 |
28 |
$1K |
| D9610 |
|
45 |
36 |
$847.19 |
| D0350 |
|
17 |
13 |
$305.76 |