| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
837 |
560 |
$241K |
| D1110 |
Prophylaxis - adult |
3,975 |
3,780 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,793 |
936 |
$124K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
187 |
164 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,143 |
631 |
$108K |
| D2950 |
|
990 |
689 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,144 |
2,671 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
648 |
302 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,090 |
2,986 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,943 |
3,842 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
6,596 |
5,251 |
$48K |
| D4355 |
|
728 |
718 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,719 |
2,639 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,679 |
3,234 |
$40K |
| D9610 |
|
3,105 |
2,834 |
$40K |
| D1120 |
Prophylaxis - child |
1,484 |
1,474 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,793 |
1,467 |
$30K |
| D9630 |
|
1,809 |
1,752 |
$27K |
| D4910 |
|
434 |
429 |
$16K |
| D0330 |
Panoramic radiographic image |
318 |
293 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,017 |
478 |
$14K |
| D9944 |
|
68 |
68 |
$13K |
| D3320 |
|
15 |
13 |
$8K |
| D4341 |
|
92 |
38 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
179 |
179 |
$3K |
| D2394 |
|
20 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
280 |
277 |
$2K |
| D1999 |
|
335 |
247 |
$0.00 |