| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
974 |
711 |
$465K |
| D0120 |
Periodic oral evaluation - established patient |
14,760 |
14,370 |
$342K |
| D1120 |
Prophylaxis - child |
10,691 |
10,400 |
$336K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,277 |
15,840 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,102 |
2,517 |
$293K |
| D1110 |
Prophylaxis - adult |
6,017 |
5,847 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,063 |
1,750 |
$207K |
| D0274 |
Bitewings - four radiographic images |
7,172 |
6,962 |
$182K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
301 |
269 |
$145K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,315 |
730 |
$138K |
| D0330 |
Panoramic radiographic image |
4,047 |
3,915 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,095 |
849 |
$125K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,062 |
309 |
$120K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,685 |
3,346 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,524 |
3,385 |
$93K |
| D0272 |
Bitewings - two radiographic images |
5,342 |
5,207 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
2,058 |
1,995 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,357 |
3,231 |
$39K |
| D2950 |
|
340 |
279 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
219 |
125 |
$18K |
| D1206 |
Topical application of fluoride varnish |
244 |
231 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
46 |
28 |
$3K |
| D4355 |
|
66 |
61 |
$3K |
| D2931 |
|
18 |
15 |
$3K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
76 |
$809.15 |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
32 |
$658.80 |
| D1330 |
|
196 |
179 |
$0.00 |
| D1999 |
|
51 |
44 |
$0.00 |