| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,170 |
780 |
$812K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,984 |
1,963 |
$608K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
776 |
637 |
$490K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,236 |
989 |
$310K |
| D1351 |
Sealant - per tooth |
9,411 |
1,369 |
$283K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,639 |
879 |
$251K |
| D1110 |
Prophylaxis - adult |
3,104 |
3,097 |
$159K |
| D2954 |
|
713 |
528 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,720 |
3,707 |
$155K |
| D0210 |
Intraoral - complete series of radiographic images |
2,341 |
2,167 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
3,099 |
3,078 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,305 |
747 |
$124K |
| D2950 |
|
669 |
515 |
$124K |
| D1120 |
Prophylaxis - child |
2,645 |
2,632 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,566 |
3,553 |
$91K |
| D3320 |
|
174 |
153 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
5,817 |
5,185 |
$91K |
| D0330 |
Panoramic radiographic image |
1,522 |
1,518 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,983 |
2,975 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,758 |
4,434 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,181 |
2,173 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
504 |
158 |
$46K |
| D7250 |
|
228 |
97 |
$39K |
| D4342 |
|
143 |
54 |
$16K |
| D4910 |
|
135 |
135 |
$11K |
| D5225 |
|
12 |
12 |
$11K |
| D0272 |
Bitewings - two radiographic images |
499 |
498 |
$10K |
| D3310 |
|
19 |
13 |
$9K |
| D4341 |
|
32 |
12 |
$6K |
| D7111 |
|
60 |
40 |
$4K |