| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,432 |
1,033 |
$676K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,738 |
4,723 |
$312K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
557 |
496 |
$257K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,174 |
1,003 |
$254K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,235 |
1,507 |
$216K |
| D0210 |
Intraoral - complete series of radiographic images |
4,227 |
4,218 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,789 |
1,257 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
1,178 |
1,171 |
$85K |
| D0350 |
|
8,730 |
2,333 |
$84K |
| D2952 |
|
573 |
430 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
735 |
487 |
$59K |
| D4341 |
|
771 |
219 |
$54K |
| D1110 |
Prophylaxis - adult |
572 |
569 |
$51K |
| D1120 |
Prophylaxis - child |
865 |
859 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,780 |
1,839 |
$40K |
| D2330 |
|
396 |
187 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,255 |
1,245 |
$27K |
| D2954 |
|
248 |
184 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,765 |
1,756 |
$25K |
| D3320 |
|
66 |
57 |
$24K |
| D9430 |
|
572 |
518 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
262 |
142 |
$17K |
| D1351 |
Sealant - per tooth |
257 |
76 |
$9K |
| D4910 |
|
96 |
96 |
$7K |
| D2331 |
|
93 |
44 |
$7K |
| D2332 |
|
79 |
55 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
36 |
$6K |
| D2160 |
|
44 |
27 |
$4K |
| D2335 |
|
23 |
14 |
$3K |
| D2140 |
|
45 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
94 |
94 |
$1K |
| D4342 |
|
26 |
13 |
$1K |
| D3221 |
|
13 |
12 |
$819.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$742.50 |