| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
540 |
398 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,111 |
3,087 |
$194K |
| D1120 |
Prophylaxis - child |
2,845 |
2,820 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
2,625 |
2,613 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,682 |
1,006 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,968 |
1,057 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
2,140 |
2,126 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,819 |
2,789 |
$79K |
| D4341 |
|
1,272 |
506 |
$78K |
| D1110 |
Prophylaxis - adult |
894 |
885 |
$74K |
| D4910 |
|
592 |
592 |
$68K |
| D1351 |
Sealant - per tooth |
2,048 |
464 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,986 |
2,761 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,096 |
2,084 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,508 |
2,473 |
$29K |
| D1206 |
Topical application of fluoride varnish |
985 |
983 |
$27K |
| D9430 |
|
834 |
825 |
$26K |
| D1310 |
|
830 |
821 |
$25K |
| D0350 |
|
1,556 |
1,029 |
$19K |
| D2952 |
|
146 |
106 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
138 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
44 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
65 |
65 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D1354 |
|
809 |
230 |
$4K |
| D0603 |
|
366 |
337 |
$3K |
| D0601 |
|
390 |
370 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
28 |
$2K |
| D4342 |
|
33 |
13 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$649.00 |
| D9993 |
|
685 |
680 |
$220.00 |
| D0270 |
|
15 |
14 |
$65.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$35.00 |