| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
4,292 |
2,799 |
$2.04M |
| D0120 |
Periodic oral evaluation - established patient |
13,728 |
13,704 |
$745K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,173 |
8,156 |
$519K |
| D1110 |
Prophylaxis - adult |
5,834 |
5,823 |
$510K |
| D0210 |
Intraoral - complete series of radiographic images |
9,756 |
9,729 |
$461K |
| D1120 |
Prophylaxis - child |
11,996 |
11,964 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,589 |
4,279 |
$430K |
| D4341 |
|
4,777 |
1,298 |
$334K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,633 |
1,446 |
$312K |
| D9430 |
|
8,390 |
8,270 |
$266K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,583 |
19,531 |
$247K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,706 |
1,844 |
$212K |
| D4910 |
|
2,542 |
2,542 |
$196K |
| D0274 |
Bitewings - four radiographic images |
8,037 |
8,018 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,926 |
1,450 |
$149K |
| D2954 |
|
1,246 |
971 |
$131K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
256 |
241 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,461 |
14,586 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,427 |
2,138 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,797 |
1,147 |
$92K |
| D1351 |
Sealant - per tooth |
3,178 |
1,168 |
$74K |
| D1320 |
|
3,999 |
3,994 |
$58K |
| D0350 |
|
4,387 |
2,124 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,444 |
4,415 |
$53K |
| D0272 |
Bitewings - two radiographic images |
3,311 |
3,306 |
$39K |
| D4342 |
|
692 |
216 |
$29K |
| D0330 |
Panoramic radiographic image |
573 |
569 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
110 |
77 |
$12K |
| D5110 |
|
13 |
13 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
77 |
53 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
140 |
$7K |
| D2394 |
|
78 |
47 |
$6K |
| D2330 |
|
85 |
59 |
$6K |
| D2335 |
|
25 |
13 |
$3K |
| D0270 |
|
25 |
25 |
$125.00 |
| D9910 |
|
16 |
16 |
$0.00 |