| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,680 |
987 |
$674K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,448 |
1,655 |
$472K |
| D9243 |
|
3,644 |
1,438 |
$242K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,956 |
1,009 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,251 |
1,470 |
$156K |
| D1110 |
Prophylaxis - adult |
3,975 |
3,881 |
$138K |
| D0140 |
Limited oral evaluation - problem focused |
5,431 |
5,205 |
$126K |
| D1206 |
Topical application of fluoride varnish |
8,157 |
7,883 |
$123K |
| D4341 |
|
1,164 |
468 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,705 |
5,543 |
$100K |
| D0274 |
Bitewings - four radiographic images |
5,283 |
5,163 |
$99K |
| D9239 |
|
1,462 |
1,412 |
$97K |
| D4910 |
|
1,604 |
1,564 |
$86K |
| D2950 |
|
881 |
780 |
$82K |
| D0330 |
Panoramic radiographic image |
3,221 |
3,114 |
$71K |
| D1120 |
Prophylaxis - child |
2,152 |
2,080 |
$53K |
| D4355 |
|
1,245 |
1,234 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
145 |
134 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,978 |
1,944 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
5,869 |
5,542 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
223 |
75 |
$39K |
| D2332 |
|
461 |
223 |
$35K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
15 |
14 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
444 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
664 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,716 |
1,657 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,025 |
1,003 |
$15K |
| D1351 |
Sealant - per tooth |
586 |
96 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,189 |
1,138 |
$10K |
| D0180 |
|
293 |
277 |
$6K |
| D7230 |
|
31 |
13 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
231 |
209 |
$5K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$5K |
| D1999 |
|
573 |
521 |
$3K |
| D7250 |
|
23 |
12 |
$2K |
| D0340 |
|
58 |
55 |
$2K |
| D2394 |
|
30 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
13 |
$2K |
| D0470 |
|
73 |
66 |
$2K |
| D2331 |
|
20 |
12 |
$1K |
| D0240 |
|
29 |
26 |
$583.60 |