| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
825 |
361 |
$451K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
305 |
220 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,411 |
718 |
$135K |
| D1120 |
Prophylaxis - child |
2,040 |
1,889 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,001 |
1,825 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,028 |
397 |
$75K |
| D2954 |
|
458 |
248 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
635 |
392 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,278 |
1,236 |
$54K |
| D1110 |
Prophylaxis - adult |
1,010 |
902 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,788 |
1,639 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
262 |
158 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
695 |
603 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,015 |
989 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,186 |
2,036 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,359 |
1,326 |
$38K |
| D1351 |
Sealant - per tooth |
714 |
184 |
$30K |
| D3320 |
|
46 |
26 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,270 |
931 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
623 |
537 |
$12K |
| D2950 |
|
68 |
43 |
$11K |
| D3120 |
|
392 |
169 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
58 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
66 |
$9K |
| D0272 |
Bitewings - two radiographic images |
297 |
287 |
$9K |
| D1206 |
Topical application of fluoride varnish |
278 |
274 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
31 |
$6K |
| D1354 |
|
153 |
29 |
$2K |
| D7311 |
|
12 |
12 |
$1K |
| D0270 |
|
77 |
71 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$648.00 |