| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
752 |
499 |
$345K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,160 |
2,104 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
4,616 |
4,592 |
$221K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,333 |
1,209 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,069 |
3,057 |
$175K |
| D4341 |
|
2,571 |
706 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,962 |
5,164 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
2,756 |
2,745 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
801 |
441 |
$90K |
| D1120 |
Prophylaxis - child |
2,629 |
2,617 |
$88K |
| D0272 |
Bitewings - two radiographic images |
4,710 |
4,685 |
$49K |
| D2954 |
|
412 |
301 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
68 |
63 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,586 |
2,572 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
433 |
219 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
43 |
26 |
$20K |
| D4342 |
|
345 |
112 |
$13K |
| D3310 |
|
43 |
26 |
$13K |
| D3320 |
|
35 |
26 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
15 |
15 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
25 |
$3K |
| D9430 |
|
78 |
76 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
95 |
$1K |
| D1330 |
|
54 |
54 |
$0.00 |