| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
906 |
772 |
$177K |
| D1110 |
Prophylaxis - adult |
5,769 |
5,648 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,519 |
3,442 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
5,650 |
5,520 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,799 |
2,159 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
2,008 |
1,979 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
2,388 |
2,341 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,590 |
3,542 |
$40K |
| D2331 |
|
788 |
581 |
$30K |
| D2950 |
|
1,109 |
977 |
$29K |
| D1120 |
Prophylaxis - child |
1,402 |
1,370 |
$27K |
| D2752 |
|
95 |
84 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
318 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
491 |
436 |
$19K |
| D1206 |
Topical application of fluoride varnish |
986 |
967 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,813 |
1,769 |
$13K |
| D0330 |
Panoramic radiographic image |
549 |
535 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
61 |
58 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,607 |
2,521 |
$9K |
| D1351 |
Sealant - per tooth |
411 |
108 |
$4K |
| D2330 |
|
140 |
110 |
$4K |
| D0272 |
Bitewings - two radiographic images |
640 |
629 |
$3K |
| D2750 |
|
12 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,158 |
827 |
$3K |
| D2954 |
|
21 |
14 |
$1K |
| D0270 |
|
403 |
391 |
$1K |
| D9944 |
|
54 |
54 |
$995.00 |
| D0601 |
|
177 |
171 |
$890.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
73 |
$521.91 |
| D2332 |
|
15 |
12 |
$437.50 |
| D0603 |
|
48 |
47 |
$170.00 |
| D0602 |
|
14 |
13 |
$60.00 |