| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,191 |
896 |
$559K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,470 |
3,455 |
$228K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
411 |
393 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
3,244 |
3,233 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,679 |
853 |
$112K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
766 |
429 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,132 |
1,127 |
$86K |
| D1110 |
Prophylaxis - adult |
875 |
871 |
$78K |
| D0350 |
|
8,001 |
2,086 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,136 |
538 |
$62K |
| D2952 |
|
473 |
381 |
$49K |
| D4341 |
|
611 |
167 |
$43K |
| D2954 |
|
385 |
288 |
$39K |
| D3320 |
|
105 |
96 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
483 |
294 |
$38K |
| D1120 |
Prophylaxis - child |
771 |
765 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,402 |
1,424 |
$31K |
| D4910 |
|
357 |
357 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,870 |
1,862 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
1,098 |
$24K |
| D9430 |
|
318 |
267 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
129 |
74 |
$9K |
| D1351 |
Sealant - per tooth |
164 |
42 |
$5K |
| D1206 |
Topical application of fluoride varnish |
347 |
346 |
$5K |
| D2335 |
|
33 |
13 |
$4K |
| D2330 |
|
41 |
12 |
$3K |
| D2140 |
|
55 |
31 |
$3K |
| D2160 |
|
23 |
13 |
$2K |
| D2394 |
|
12 |
12 |
$1K |
| D3221 |
|
12 |
12 |
$756.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
24 |
$324.00 |
| D0330 |
Panoramic radiographic image |
309 |
309 |
$180.00 |