| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
557 |
373 |
$283K |
| D1110 |
Prophylaxis - adult |
4,514 |
4,264 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,323 |
608 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,935 |
1,108 |
$127K |
| D1354 |
|
14,478 |
1,949 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,489 |
4,257 |
$121K |
| D0330 |
Panoramic radiographic image |
3,294 |
2,996 |
$107K |
| D1351 |
Sealant - per tooth |
3,841 |
899 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,687 |
877 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,382 |
4,167 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,815 |
1,636 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,765 |
2,575 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
641 |
458 |
$47K |
| D1120 |
Prophylaxis - child |
1,625 |
1,509 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,529 |
2,233 |
$44K |
| D5110 |
|
71 |
69 |
$44K |
| D4355 |
|
757 |
729 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,553 |
3,222 |
$36K |
| D3320 |
|
67 |
59 |
$32K |
| D5120 |
|
54 |
52 |
$32K |
| D3310 |
|
69 |
38 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,408 |
1,297 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
259 |
78 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,382 |
2,204 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
35 |
28 |
$23K |
| D2332 |
|
250 |
132 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
631 |
576 |
$18K |
| D2331 |
|
153 |
109 |
$11K |
| D2335 |
|
121 |
60 |
$11K |
| D2330 |
|
118 |
74 |
$6K |
| D2954 |
|
175 |
120 |
$6K |
| D0272 |
Bitewings - two radiographic images |
415 |
350 |
$6K |
| D4341 |
|
48 |
24 |
$6K |
| D4342 |
|
168 |
64 |
$5K |
| D9110 |
|
169 |
156 |
$3K |
| D2394 |
|
22 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
32 |
$699.05 |
| D2950 |
|
17 |
14 |
$133.07 |
| D1330 |
|
55 |
54 |
$0.00 |
| D1310 |
|
28 |
28 |
$0.00 |
| D9910 |
|
70 |
67 |
$0.00 |
| D0350 |
|
148 |
70 |
$0.00 |
| D0180 |
|
14 |
14 |
$0.00 |