| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,004 |
759 |
$477K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,641 |
3,616 |
$240K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,947 |
1,063 |
$229K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
396 |
372 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
3,085 |
3,065 |
$146K |
| D1351 |
Sealant - per tooth |
2,976 |
803 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,610 |
916 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
979 |
977 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
787 |
543 |
$62K |
| D1120 |
Prophylaxis - child |
1,198 |
1,196 |
$61K |
| D2952 |
|
405 |
337 |
$41K |
| D4910 |
|
487 |
486 |
$37K |
| D1110 |
Prophylaxis - adult |
411 |
409 |
$36K |
| D4341 |
|
473 |
128 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,807 |
1,703 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,677 |
1,673 |
$26K |
| D0330 |
Panoramic radiographic image |
806 |
799 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
369 |
207 |
$20K |
| D0274 |
Bitewings - four radiographic images |
950 |
950 |
$19K |
| D2335 |
|
84 |
50 |
$10K |
| D3320 |
|
26 |
24 |
$10K |
| D9430 |
|
249 |
247 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
35 |
13 |
$8K |
| D2394 |
|
88 |
72 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
394 |
390 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
50 |
$5K |
| D0272 |
Bitewings - two radiographic images |
271 |
267 |
$3K |
| D7230 |
|
18 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
112 |
$1K |
| D1310 |
|
12 |
12 |
$92.00 |
| D0270 |
|
12 |
12 |
$60.00 |