| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
310 |
193 |
$211K |
| D1110 |
Prophylaxis - adult |
2,995 |
2,754 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,046 |
565 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
3,177 |
2,976 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,472 |
1,421 |
$53K |
| D1120 |
Prophylaxis - child |
1,171 |
1,071 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,498 |
3,190 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,251 |
1,129 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,048 |
951 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
322 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,373 |
1,274 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,365 |
2,103 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
439 |
420 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
196 |
113 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
34 |
29 |
$21K |
| D2954 |
|
97 |
65 |
$17K |
| D2950 |
|
92 |
59 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
13 |
$10K |
| D3320 |
|
16 |
14 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$416.00 |