| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
387 |
263 |
$279K |
| D1110 |
Prophylaxis - adult |
4,129 |
4,025 |
$214K |
| D0274 |
Bitewings - four radiographic images |
3,100 |
3,041 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,252 |
4,176 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,319 |
1,275 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,110 |
2,040 |
$87K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
75 |
68 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,135 |
1,069 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,086 |
1,078 |
$31K |
| D1120 |
Prophylaxis - child |
597 |
592 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
28 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,271 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
97 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
50 |
$14K |
| D4342 |
|
143 |
43 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
27 |
$4K |
| D2954 |
|
17 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$644.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
26 |
$279.00 |