| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,277 |
961 |
$598K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,935 |
3,490 |
$446K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,681 |
4,655 |
$292K |
| D0350 |
|
31,240 |
8,006 |
$286K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,347 |
2,031 |
$258K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,148 |
2,154 |
$217K |
| D9430 |
|
6,598 |
5,773 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
3,248 |
3,233 |
$198K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,618 |
1,000 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
3,752 |
3,726 |
$174K |
| D1110 |
Prophylaxis - adult |
2,036 |
2,029 |
$172K |
| D0330 |
Panoramic radiographic image |
4,691 |
4,654 |
$137K |
| D1120 |
Prophylaxis - child |
3,271 |
3,250 |
$123K |
| D2954 |
|
1,002 |
820 |
$103K |
| D2330 |
|
1,280 |
759 |
$93K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
180 |
166 |
$79K |
| D1206 |
Topical application of fluoride varnish |
5,085 |
5,063 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,473 |
2,463 |
$51K |
| D1351 |
Sealant - per tooth |
1,491 |
428 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,271 |
3,110 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,376 |
5,047 |
$38K |
| D4341 |
|
475 |
123 |
$33K |
| D4910 |
|
233 |
233 |
$17K |
| D3320 |
|
41 |
39 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,183 |
1,177 |
$14K |
| D2332 |
|
132 |
88 |
$11K |
| D2331 |
|
82 |
62 |
$6K |
| D2394 |
|
31 |
24 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
231 |
227 |
$2K |
| D0270 |
|
12 |
12 |
$60.00 |
| D1999 |
|
398 |
396 |
$0.00 |