| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
7,932 |
3,424 |
$763K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,936 |
1,198 |
$392K |
| D2740 |
Crown - porcelain/ceramic |
415 |
217 |
$256K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,094 |
566 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,584 |
722 |
$164K |
| D1120 |
Prophylaxis - child |
3,434 |
3,407 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,918 |
2,870 |
$121K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
799 |
155 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,253 |
4,211 |
$110K |
| D1110 |
Prophylaxis - adult |
1,963 |
1,940 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,983 |
2,962 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,247 |
1,226 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,983 |
4,914 |
$64K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
116 |
101 |
$63K |
| D2950 |
|
476 |
343 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,498 |
1,482 |
$46K |
| D1354 |
|
778 |
188 |
$42K |
| D8660 |
|
293 |
293 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
248 |
146 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,819 |
2,795 |
$36K |
| D2394 |
|
173 |
106 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,544 |
1,531 |
$33K |
| D1351 |
Sealant - per tooth |
672 |
204 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
741 |
724 |
$27K |
| D0272 |
Bitewings - two radiographic images |
856 |
851 |
$19K |
| D0460 |
|
491 |
475 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
365 |
356 |
$12K |
| D0330 |
Panoramic radiographic image |
232 |
232 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
331 |
317 |
$11K |
| D1353 |
|
144 |
49 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$2K |
| D0340 |
|
35 |
35 |
$2K |
| D2330 |
|
16 |
13 |
$2K |
| D0160 |
|
12 |
12 |
$857.04 |