| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,193 |
840 |
$720K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
486 |
473 |
$267K |
| D2950 |
|
1,229 |
994 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,447 |
919 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,685 |
624 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,764 |
2,761 |
$112K |
| D1351 |
Sealant - per tooth |
3,770 |
429 |
$105K |
| D3320 |
|
235 |
203 |
$104K |
| D0330 |
Panoramic radiographic image |
2,149 |
2,146 |
$102K |
| D4341 |
|
709 |
235 |
$99K |
| D4342 |
|
1,157 |
375 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
837 |
545 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
508 |
354 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
455 |
341 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,458 |
1,447 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,272 |
2,270 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,967 |
3,856 |
$56K |
| D1110 |
Prophylaxis - adult |
1,105 |
1,105 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,744 |
2,780 |
$43K |
| D3310 |
|
107 |
85 |
$37K |
| D7250 |
|
266 |
102 |
$35K |
| D1120 |
Prophylaxis - child |
815 |
815 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,227 |
1,227 |
$32K |
| D4346 |
|
445 |
444 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
752 |
752 |
$20K |
| D4910 |
|
241 |
241 |
$20K |
| D2790 |
|
33 |
27 |
$19K |
| D2954 |
|
98 |
72 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
27 |
14 |
$8K |
| D2330 |
|
98 |
65 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
329 |
$7K |
| D7230 |
|
37 |
27 |
$7K |
| D2332 |
|
62 |
37 |
$6K |
| D2331 |
|
59 |
47 |
$5K |
| D0272 |
Bitewings - two radiographic images |
241 |
241 |
$4K |
| D2335 |
|
13 |
12 |
$2K |