| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,429 |
628 |
$793K |
| D3310 |
|
666 |
271 |
$233K |
| D2950 |
|
1,454 |
753 |
$206K |
| D3320 |
|
468 |
349 |
$194K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
208 |
195 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,428 |
454 |
$104K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
743 |
500 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,452 |
1,448 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,044 |
2,035 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
599 |
352 |
$69K |
| D1110 |
Prophylaxis - adult |
995 |
993 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
733 |
703 |
$27K |
| D4341 |
|
157 |
63 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,223 |
1,200 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
77 |
$16K |
| D0274 |
Bitewings - four radiographic images |
585 |
583 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
580 |
579 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
92 |
$13K |
| D1120 |
Prophylaxis - child |
293 |
293 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,067 |
650 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
436 |
435 |
$6K |
| D0330 |
Panoramic radiographic image |
190 |
188 |
$5K |
| D4355 |
|
14 |
13 |
$889.90 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$600.00 |
| D0270 |
|
33 |
33 |
$324.38 |