| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,920 |
1,099 |
$1.32M |
| D1110 |
Prophylaxis - adult |
10,590 |
10,361 |
$580K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,761 |
3,301 |
$543K |
| D1120 |
Prophylaxis - child |
6,036 |
5,942 |
$300K |
| D0120 |
Periodic oral evaluation - established patient |
10,773 |
10,582 |
$274K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,482 |
9,340 |
$268K |
| D1351 |
Sealant - per tooth |
6,348 |
2,075 |
$243K |
| D0274 |
Bitewings - four radiographic images |
6,480 |
6,371 |
$240K |
| D0210 |
Intraoral - complete series of radiographic images |
3,149 |
3,070 |
$236K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,071 |
1,910 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,744 |
2,688 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,084 |
784 |
$103K |
| D0272 |
Bitewings - two radiographic images |
3,652 |
3,590 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
816 |
450 |
$78K |
| D9110 |
|
1,721 |
1,650 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,002 |
3,878 |
$62K |
| D0330 |
Panoramic radiographic image |
1,039 |
1,017 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,385 |
1,334 |
$54K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
78 |
65 |
$53K |
| D2954 |
|
204 |
151 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,143 |
2,045 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
179 |
74 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
71 |
42 |
$6K |
| D7111 |
|
73 |
51 |
$6K |
| D3120 |
|
131 |
97 |
$5K |
| D2330 |
|
58 |
37 |
$5K |
| D4211 |
|
46 |
42 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
91 |
91 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$2K |
| D1999 |
|
13 |
12 |
$0.00 |