| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,471 |
1,075 |
$683K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,840 |
698 |
$244K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
373 |
337 |
$225K |
| D0210 |
Intraoral - complete series of radiographic images |
3,004 |
2,943 |
$158K |
| D2954 |
|
1,254 |
963 |
$144K |
| D1110 |
Prophylaxis - adult |
3,156 |
3,079 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
3,386 |
3,323 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
3,111 |
3,022 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
808 |
524 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,098 |
2,053 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,064 |
2,015 |
$36K |
| D1120 |
Prophylaxis - child |
1,387 |
1,373 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,319 |
2,296 |
$34K |
| D3320 |
|
62 |
54 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,706 |
3,560 |
$26K |
| D1351 |
Sealant - per tooth |
1,303 |
166 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
188 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
116 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,866 |
2,295 |
$11K |
| D0330 |
Panoramic radiographic image |
385 |
367 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
80 |
$7K |
| D4341 |
|
34 |
12 |
$3K |
| D0270 |
|
289 |
287 |
$2K |
| D0272 |
Bitewings - two radiographic images |
143 |
137 |
$2K |
| D9310 |
|
39 |
39 |
$858.00 |
| D4355 |
|
12 |
12 |
$600.00 |
| D1206 |
Topical application of fluoride varnish |
60 |
60 |
$360.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$215.00 |
| D0350 |
|
14 |
14 |
$26.50 |