| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,609 |
2,028 |
$1.56M |
| D1110 |
Prophylaxis - adult |
15,160 |
15,154 |
$799K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,021 |
4,667 |
$783K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,446 |
3,941 |
$573K |
| D0120 |
Periodic oral evaluation - established patient |
18,432 |
18,422 |
$492K |
| D1120 |
Prophylaxis - child |
8,206 |
8,199 |
$373K |
| D0210 |
Intraoral - complete series of radiographic images |
5,489 |
5,487 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,185 |
8,182 |
$262K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
587 |
571 |
$253K |
| D2954 |
|
1,460 |
1,339 |
$234K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,185 |
2,407 |
$227K |
| D1351 |
Sealant - per tooth |
3,767 |
1,304 |
$184K |
| D0274 |
Bitewings - four radiographic images |
6,009 |
6,008 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,144 |
8,141 |
$137K |
| D1206 |
Topical application of fluoride varnish |
3,343 |
3,340 |
$99K |
| D0272 |
Bitewings - two radiographic images |
4,660 |
4,658 |
$86K |
| D0330 |
Panoramic radiographic image |
2,148 |
2,147 |
$86K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
340 |
172 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,062 |
4,048 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,565 |
3,534 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
2,997 |
2,989 |
$47K |
| D2331 |
|
377 |
304 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
273 |
$36K |
| D8670 |
Periodic orthodontic treatment visit |
80 |
77 |
$21K |
| D3320 |
|
59 |
57 |
$19K |
| D5110 |
|
26 |
26 |
$17K |
| D2330 |
|
232 |
173 |
$15K |
| D0340 |
|
132 |
132 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
53 |
$7K |
| D0240 |
|
287 |
197 |
$7K |
| D2335 |
|
40 |
38 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
109 |
108 |
$3K |
| D0470 |
|
60 |
60 |
$2K |
| D0350 |
|
139 |
139 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
316 |
309 |
$0.00 |