| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,912 |
1,231 |
$1.24M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
702 |
673 |
$423K |
| D2950 |
|
2,415 |
1,746 |
$399K |
| D2790 |
|
594 |
521 |
$387K |
| D1110 |
Prophylaxis - adult |
7,117 |
7,103 |
$330K |
| D4341 |
|
2,331 |
770 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,172 |
1,500 |
$243K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,185 |
1,653 |
$243K |
| D0210 |
Intraoral - complete series of radiographic images |
4,047 |
4,001 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
7,653 |
7,643 |
$195K |
| D0140 |
Limited oral evaluation - problem focused |
6,601 |
6,452 |
$192K |
| D3320 |
|
361 |
334 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,094 |
1,084 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,959 |
3,955 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,344 |
657 |
$125K |
| D1351 |
Sealant - per tooth |
3,583 |
508 |
$111K |
| D1120 |
Prophylaxis - child |
2,424 |
2,422 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,813 |
2,809 |
$82K |
| D0330 |
Panoramic radiographic image |
1,483 |
1,480 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,742 |
2,740 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,947 |
4,848 |
$65K |
| D2753 |
|
81 |
73 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
284 |
230 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,721 |
1,721 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,597 |
2,999 |
$38K |
| D4910 |
|
351 |
351 |
$30K |
| D3310 |
|
51 |
38 |
$21K |
| D2750 |
|
29 |
25 |
$18K |
| D4355 |
|
462 |
459 |
$17K |
| D1206 |
Topical application of fluoride varnish |
575 |
575 |
$17K |
| D2394 |
|
194 |
180 |
$13K |
| D7111 |
|
118 |
82 |
$8K |
| D2332 |
|
23 |
13 |
$3K |
| D2335 |
|
15 |
12 |
$1K |