| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
822 |
417 |
$645K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,943 |
2,347 |
$442K |
| D1110 |
Prophylaxis - adult |
10,113 |
9,625 |
$389K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,636 |
2,428 |
$295K |
| D0330 |
Panoramic radiographic image |
5,822 |
5,476 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
10,792 |
10,384 |
$210K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,249 |
1,741 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,151 |
5,818 |
$179K |
| D1351 |
Sealant - per tooth |
5,932 |
1,473 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,379 |
8,035 |
$142K |
| D1120 |
Prophylaxis - child |
5,907 |
5,676 |
$131K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,227 |
805 |
$99K |
| D0272 |
Bitewings - two radiographic images |
10,054 |
9,380 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,658 |
3,599 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
9,193 |
7,737 |
$52K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
85 |
74 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,792 |
1,648 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,811 |
3,440 |
$41K |
| D2950 |
|
302 |
205 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,652 |
980 |
$27K |
| D9944 |
|
67 |
67 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
214 |
115 |
$12K |
| D2954 |
|
45 |
37 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
12 |
$7K |
| D2140 |
|
93 |
54 |
$4K |
| D2160 |
|
41 |
28 |
$3K |
| D9243 |
|
40 |
12 |
$1K |
| D9239 |
|
12 |
12 |
$560.00 |
| D3120 |
|
33 |
27 |
$0.00 |
| D1330 |
|
17 |
17 |
$0.00 |