| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,864 |
3,791 |
$218K |
| D2740 |
Crown - porcelain/ceramic |
374 |
266 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,497 |
1,299 |
$164K |
| D1120 |
Prophylaxis - child |
4,094 |
4,015 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,496 |
2,463 |
$155K |
| D4910 |
|
1,425 |
1,413 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,490 |
4,829 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,860 |
984 |
$99K |
| D9430 |
|
2,853 |
2,537 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,892 |
1,867 |
$88K |
| D4341 |
|
1,248 |
321 |
$87K |
| D1110 |
Prophylaxis - adult |
778 |
772 |
$68K |
| D1206 |
Topical application of fluoride varnish |
5,056 |
4,964 |
$64K |
| D1351 |
Sealant - per tooth |
2,428 |
715 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,259 |
1,192 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,286 |
2,248 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
305 |
$30K |
| D0350 |
|
3,290 |
1,340 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
222 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,871 |
1,837 |
$21K |
| D2954 |
|
118 |
91 |
$12K |
| D9993 |
|
176 |
176 |
$9K |
| D1310 |
|
191 |
191 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
16 |
$8K |
| D4342 |
|
46 |
13 |
$2K |
| D0603 |
|
97 |
97 |
$1K |
| D2330 |
|
16 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$690.00 |
| D0270 |
|
69 |
68 |
$345.00 |
| D0601 |
|
13 |
13 |
$195.00 |