| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,117 |
1,578 |
$974K |
| D8670 |
Periodic orthodontic treatment visit |
9,228 |
8,509 |
$533K |
| D1110 |
Prophylaxis - adult |
8,823 |
8,615 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
13,793 |
13,473 |
$281K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,594 |
2,256 |
$270K |
| D0210 |
Intraoral - complete series of radiographic images |
4,728 |
4,660 |
$251K |
| D1351 |
Sealant - per tooth |
13,173 |
1,835 |
$250K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,287 |
15,912 |
$237K |
| D1120 |
Prophylaxis - child |
8,157 |
8,034 |
$216K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,143 |
1,097 |
$180K |
| D2954 |
|
1,316 |
994 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,799 |
5,676 |
$134K |
| D0274 |
Bitewings - four radiographic images |
5,982 |
5,815 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,584 |
1,087 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
10,909 |
10,421 |
$74K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
144 |
136 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
3,231 |
3,126 |
$63K |
| D4910 |
|
819 |
795 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
523 |
400 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,639 |
7,594 |
$46K |
| D9310 |
|
1,412 |
1,396 |
$32K |
| D0330 |
Panoramic radiographic image |
1,062 |
1,041 |
$31K |
| D4341 |
|
339 |
117 |
$31K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
39 |
37 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
554 |
236 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,619 |
1,424 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,499 |
1,494 |
$18K |
| D8680 |
|
12 |
12 |
$13K |
| D0602 |
|
580 |
580 |
$6K |
| D1353 |
|
540 |
61 |
$5K |
| D0601 |
|
546 |
544 |
$5K |
| D8660 |
|
113 |
110 |
$5K |
| D2950 |
|
96 |
63 |
$5K |
| D4355 |
|
92 |
92 |
$5K |
| D2331 |
|
63 |
37 |
$4K |
| D0270 |
|
538 |
533 |
$4K |
| D0180 |
|
169 |
167 |
$4K |
| D2335 |
|
19 |
12 |
$2K |
| D4342 |
|
40 |
17 |
$2K |
| D1206 |
Topical application of fluoride varnish |
219 |
219 |
$1K |
| D9920 |
|
48 |
48 |
$844.00 |
| D0603 |
|
73 |
73 |
$610.00 |
| D0350 |
|
331 |
317 |
$376.50 |