| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
826 |
511 |
$381K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,448 |
434 |
$171K |
| D1110 |
Prophylaxis - adult |
2,730 |
2,600 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,581 |
433 |
$98K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
160 |
123 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,570 |
4,240 |
$89K |
| D0330 |
Panoramic radiographic image |
2,274 |
2,108 |
$86K |
| D5110 |
|
123 |
117 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,498 |
841 |
$77K |
| D1120 |
Prophylaxis - child |
2,063 |
1,927 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
528 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,281 |
2,111 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,632 |
2,455 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,669 |
1,562 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,436 |
1,342 |
$30K |
| D5120 |
|
41 |
41 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,041 |
1,867 |
$23K |
| D2950 |
|
604 |
372 |
$14K |
| D0272 |
Bitewings - two radiographic images |
889 |
809 |
$14K |
| D3310 |
|
24 |
13 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,435 |
772 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
59 |
$8K |
| D7250 |
|
49 |
15 |
$6K |
| D3320 |
|
12 |
12 |
$6K |
| D2330 |
|
113 |
64 |
$5K |
| D0160 |
|
102 |
96 |
$4K |
| D1206 |
Topical application of fluoride varnish |
157 |
155 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
31 |
$2K |
| D2332 |
|
18 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
30 |
$852.34 |
| D0431 |
|
4,660 |
4,334 |
$25.75 |
| D1330 |
|
4,659 |
4,329 |
$0.00 |