| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0604 |
|
89,749 |
44,055 |
$3.54M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,331 |
1,902 |
$243K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,723 |
1,459 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,033 |
1,643 |
$207K |
| D0330 |
Panoramic radiographic image |
3,071 |
2,947 |
$194K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
299 |
276 |
$191K |
| D1110 |
Prophylaxis - adult |
4,070 |
3,919 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,170 |
4,021 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,302 |
875 |
$108K |
| D2330 |
|
1,266 |
602 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,387 |
3,289 |
$79K |
| D2740 |
Crown - porcelain/ceramic |
83 |
70 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,293 |
2,230 |
$62K |
| D2332 |
|
468 |
296 |
$53K |
| D1120 |
Prophylaxis - child |
1,802 |
1,741 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,347 |
2,267 |
$51K |
| D2331 |
|
308 |
198 |
$27K |
| D3320 |
|
47 |
47 |
$26K |
| D0350 |
|
974 |
954 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,948 |
1,880 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,453 |
1,403 |
$11K |
| D2335 |
|
100 |
53 |
$9K |
| D1206 |
Topical application of fluoride varnish |
342 |
336 |
$9K |
| D0272 |
Bitewings - two radiographic images |
472 |
463 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
65 |
25 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
187 |
$5K |
| D1351 |
Sealant - per tooth |
58 |
16 |
$3K |
| D2394 |
|
20 |
14 |
$2K |
| D2931 |
|
13 |
13 |
$2K |
| D2160 |
|
23 |
15 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
14 |
$1K |