| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
706 |
570 |
$333K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,722 |
2,444 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,269 |
4,175 |
$241K |
| D4910 |
|
1,465 |
1,464 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
3,572 |
3,505 |
$156K |
| D1110 |
Prophylaxis - adult |
1,757 |
1,755 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,572 |
1,525 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,619 |
5,193 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
2,396 |
2,391 |
$108K |
| D2332 |
|
1,058 |
280 |
$90K |
| D4341 |
|
1,306 |
546 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,612 |
1,360 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,625 |
5,448 |
$69K |
| D9310 |
|
1,392 |
1,339 |
$66K |
| D1206 |
Topical application of fluoride varnish |
4,061 |
4,041 |
$63K |
| D0350 |
|
12,756 |
4,498 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,253 |
2,250 |
$48K |
| D9430 |
|
1,489 |
1,434 |
$45K |
| D2331 |
|
523 |
181 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
512 |
403 |
$40K |
| D2330 |
|
472 |
231 |
$36K |
| D0330 |
Panoramic radiographic image |
665 |
661 |
$31K |
| D1120 |
Prophylaxis - child |
813 |
806 |
$30K |
| D1999 |
|
7,737 |
6,960 |
$26K |
| D1320 |
|
2,023 |
2,021 |
$18K |
| D4342 |
|
404 |
192 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
101 |
38 |
$17K |
| D9993 |
|
773 |
737 |
$15K |
| D1310 |
|
839 |
802 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
127 |
$11K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
37 |
14 |
$10K |
| D1351 |
Sealant - per tooth |
137 |
71 |
$4K |
| D0270 |
|
656 |
637 |
$3K |
| D0603 |
|
656 |
622 |
$2K |
| D9222 |
|
16 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
105 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
60 |
59 |
$184.00 |
| D0431 |
|
721 |
716 |
$0.00 |
| D2950 |
|
46 |
41 |
$0.00 |
| D4999 |
|
67 |
56 |
$0.00 |