| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,893 |
1,674 |
$966K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,043 |
3,876 |
$768K |
| D1110 |
Prophylaxis - adult |
17,082 |
16,818 |
$653K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,343 |
4,047 |
$515K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,436 |
2,526 |
$470K |
| D2950 |
|
4,397 |
3,313 |
$458K |
| D1351 |
Sealant - per tooth |
17,773 |
2,291 |
$406K |
| D0210 |
Intraoral - complete series of radiographic images |
7,479 |
7,359 |
$343K |
| D1208 |
Topical application of fluoride, excluding varnish |
21,780 |
21,375 |
$342K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,844 |
12,526 |
$306K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,948 |
16,700 |
$291K |
| D5110 |
|
538 |
508 |
$284K |
| D3320 |
|
888 |
749 |
$282K |
| D3310 |
|
956 |
645 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
13,219 |
12,927 |
$248K |
| D0220 |
Intraoral - periapical first radiographic image |
21,961 |
21,002 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,354 |
2,259 |
$216K |
| D0274 |
Bitewings - four radiographic images |
9,226 |
8,981 |
$206K |
| D1120 |
Prophylaxis - child |
6,279 |
6,039 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,002 |
1,490 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
5,588 |
5,381 |
$142K |
| D5214 |
|
237 |
208 |
$126K |
| D5120 |
|
209 |
199 |
$112K |
| D4341 |
|
1,118 |
402 |
$104K |
| D2331 |
|
1,482 |
942 |
$96K |
| D5213 |
|
174 |
147 |
$90K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
217 |
202 |
$82K |
| D2332 |
|
881 |
591 |
$64K |
| D2330 |
|
913 |
526 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,916 |
1,863 |
$30K |
| D1206 |
Topical application of fluoride varnish |
2,148 |
2,011 |
$29K |
| D2335 |
|
205 |
149 |
$17K |
| D0330 |
Panoramic radiographic image |
663 |
656 |
$16K |
| D9944 |
|
26 |
26 |
$6K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
80 |
$5K |
| D2394 |
|
58 |
44 |
$5K |
| D2940 |
|
138 |
117 |
$2K |
| D7230 |
|
14 |
12 |
$2K |
| D0603 |
|
142 |
121 |
$106.00 |
| D0270 |
|
16 |
15 |
$95.32 |
| D0601 |
|
15 |
14 |
$0.00 |