| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22,367 |
11,793 |
$3.01M |
| D2740 |
Crown - porcelain/ceramic |
5,011 |
3,414 |
$2.88M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14,861 |
9,392 |
$2.41M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,236 |
4,875 |
$1.29M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,170 |
2,950 |
$695K |
| D2394 |
|
3,465 |
2,732 |
$667K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,873 |
1,706 |
$629K |
| D1110 |
Prophylaxis - adult |
12,483 |
12,301 |
$571K |
| D0210 |
Intraoral - complete series of radiographic images |
9,461 |
9,115 |
$571K |
| D2950 |
|
4,234 |
2,926 |
$549K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,926 |
12,731 |
$519K |
| D0120 |
Periodic oral evaluation - established patient |
18,417 |
18,139 |
$439K |
| D0140 |
Limited oral evaluation - problem focused |
12,016 |
11,724 |
$420K |
| D1120 |
Prophylaxis - child |
8,470 |
8,330 |
$294K |
| D0274 |
Bitewings - four radiographic images |
9,814 |
9,663 |
$290K |
| D0220 |
Intraoral - periapical first radiographic image |
22,017 |
20,843 |
$273K |
| D2332 |
|
1,665 |
1,095 |
$248K |
| D4342 |
|
2,546 |
1,054 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,059 |
1,377 |
$216K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
256 |
242 |
$214K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,355 |
1,102 |
$204K |
| D1351 |
Sealant - per tooth |
5,385 |
1,570 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,444 |
6,309 |
$186K |
| D2335 |
|
917 |
500 |
$161K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,574 |
3,944 |
$144K |
| D1206 |
Topical application of fluoride varnish |
6,982 |
6,860 |
$135K |
| D0240 |
|
3,448 |
3,405 |
$102K |
| D3120 |
|
2,675 |
1,154 |
$100K |
| D0460 |
|
3,521 |
3,354 |
$93K |
| D3320 |
|
129 |
116 |
$91K |
| D4341 |
|
294 |
123 |
$68K |
| D0330 |
Panoramic radiographic image |
1,105 |
1,089 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,927 |
1,883 |
$40K |
| D9420 |
|
172 |
170 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
599 |
579 |
$19K |
| D2331 |
|
130 |
88 |
$15K |
| D1510 |
|
70 |
56 |
$10K |
| D1354 |
|
145 |
25 |
$8K |
| D0270 |
|
353 |
347 |
$5K |
| D3910 |
|
28 |
25 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$276.25 |