| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,103 |
1,436 |
$1.45M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,727 |
1,690 |
$388K |
| D1110 |
Prophylaxis - adult |
7,039 |
6,919 |
$364K |
| D0330 |
Panoramic radiographic image |
4,389 |
4,290 |
$275K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
348 |
318 |
$242K |
| D0140 |
Limited oral evaluation - problem focused |
6,111 |
5,863 |
$236K |
| D2950 |
|
1,344 |
1,047 |
$209K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
333 |
233 |
$188K |
| D0274 |
Bitewings - four radiographic images |
5,349 |
5,256 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
7,217 |
7,116 |
$173K |
| D4381 |
|
1,783 |
170 |
$146K |
| D1120 |
Prophylaxis - child |
2,275 |
2,248 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,650 |
7,172 |
$110K |
| D6059 |
|
141 |
56 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,203 |
3,176 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,043 |
736 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,849 |
1,816 |
$78K |
| D6010 |
|
58 |
26 |
$62K |
| D6057 |
|
128 |
41 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,411 |
2,430 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
409 |
267 |
$26K |
| D3320 |
|
28 |
25 |
$11K |
| D2954 |
|
69 |
49 |
$11K |
| D4341 |
|
89 |
28 |
$11K |
| D1206 |
Topical application of fluoride varnish |
279 |
276 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
50 |
$7K |
| D4342 |
|
37 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$966.00 |
| D4910 |
|
12 |
12 |
$900.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$278.00 |
| D9450 |
|
18 |
15 |
$0.00 |
| D1330 |
|
25 |
25 |
$0.00 |