| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,027 |
1,347 |
$1.15M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,142 |
4,043 |
$814K |
| D1110 |
Prophylaxis - adult |
8,569 |
8,552 |
$396K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,800 |
1,910 |
$383K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,997 |
2,514 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
12,235 |
12,215 |
$311K |
| D1120 |
Prophylaxis - child |
7,666 |
7,658 |
$298K |
| D2950 |
|
1,941 |
1,391 |
$275K |
| D0210 |
Intraoral - complete series of radiographic images |
4,495 |
4,416 |
$271K |
| D1351 |
Sealant - per tooth |
9,137 |
1,922 |
$267K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,845 |
984 |
$251K |
| D1206 |
Topical application of fluoride varnish |
9,547 |
9,527 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,790 |
5,776 |
$225K |
| D0274 |
Bitewings - four radiographic images |
5,432 |
5,415 |
$167K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
262 |
248 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
3,696 |
3,639 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
9,214 |
9,048 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,426 |
702 |
$96K |
| D4341 |
|
736 |
280 |
$89K |
| D2332 |
|
725 |
458 |
$82K |
| D4342 |
|
1,002 |
420 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,134 |
6,713 |
$70K |
| D3320 |
|
153 |
135 |
$61K |
| D4910 |
|
823 |
822 |
$55K |
| D2335 |
|
350 |
215 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,378 |
1,374 |
$31K |
| D2331 |
|
359 |
239 |
$30K |
| D0330 |
Panoramic radiographic image |
527 |
527 |
$27K |
| D2330 |
|
282 |
181 |
$19K |
| D2394 |
|
96 |
77 |
$16K |
| D3310 |
|
23 |
18 |
$8K |
| D0180 |
|
99 |
99 |
$5K |
| D4355 |
|
48 |
48 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$518.00 |
| D1999 |
|
185 |
181 |
$0.00 |
| D4921 |
|
26 |
12 |
$0.00 |