| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
580 |
362 |
$280K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,014 |
225 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,058 |
967 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
506 |
186 |
$56K |
| D1110 |
Prophylaxis - adult |
1,285 |
1,182 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
729 |
443 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,342 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,374 |
1,264 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
829 |
716 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
24 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
204 |
$18K |
| D7250 |
|
120 |
41 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
652 |
598 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
829 |
$10K |
| D5110 |
|
14 |
14 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
933 |
455 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
70 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
326 |
294 |
$7K |
| D0274 |
Bitewings - four radiographic images |
200 |
182 |
$5K |
| D1351 |
Sealant - per tooth |
110 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
71 |
67 |
$3K |
| D1120 |
Prophylaxis - child |
92 |
85 |
$3K |
| D2331 |
|
13 |
12 |
$879.23 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$243.23 |