| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
2,257 |
1,681 |
$1.27M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,701 |
1,526 |
$1.17M |
| D1110 |
Prophylaxis - adult |
20,046 |
19,900 |
$889K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,930 |
7,887 |
$747K |
| D3320 |
|
943 |
793 |
$563K |
| D0210 |
Intraoral - complete series of radiographic images |
6,962 |
6,918 |
$379K |
| D0120 |
Periodic oral evaluation - established patient |
20,534 |
20,360 |
$368K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,686 |
2,720 |
$289K |
| D2954 |
|
1,995 |
1,535 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,288 |
18,119 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,201 |
3,536 |
$217K |
| D4341 |
|
2,879 |
1,149 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,546 |
5,515 |
$160K |
| D0274 |
Bitewings - four radiographic images |
10,034 |
9,949 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
19,638 |
19,130 |
$149K |
| D1120 |
Prophylaxis - child |
5,285 |
5,256 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,474 |
16,530 |
$97K |
| D2740 |
Crown - porcelain/ceramic |
85 |
75 |
$47K |
| D3310 |
|
85 |
55 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,462 |
2,385 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,997 |
1,994 |
$26K |
| D2335 |
|
224 |
152 |
$21K |
| D2332 |
|
210 |
158 |
$17K |
| D3331 |
|
245 |
189 |
$12K |
| D2331 |
|
156 |
128 |
$10K |
| D2330 |
|
158 |
98 |
$8K |
| D9110 |
|
197 |
189 |
$5K |
| D9940 |
|
12 |
12 |
$4K |
| D2950 |
|
31 |
27 |
$3K |
| D2394 |
|
33 |
31 |
$3K |
| D0602 |
|
319 |
319 |
$3K |
| D4910 |
|
44 |
44 |
$3K |
| D1351 |
Sealant - per tooth |
128 |
13 |
$3K |
| D0191 |
|
50 |
48 |
$750.00 |
| D3910 |
|
138 |
110 |
$690.00 |
| D2940 |
|
12 |
12 |
$516.00 |
| D0603 |
|
12 |
12 |
$120.00 |
| D9610 |
|
56 |
54 |
$112.00 |