| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
147 |
115 |
$88K |
| D1110 |
Prophylaxis - adult |
1,849 |
1,826 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
775 |
446 |
$60K |
| D0330 |
Panoramic radiographic image |
1,305 |
1,023 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
317 |
211 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
468 |
156 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,603 |
1,593 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,529 |
1,269 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,253 |
1,244 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,473 |
1,342 |
$20K |
| D2950 |
|
155 |
131 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,252 |
1,164 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
310 |
291 |
$6K |
| D1206 |
Topical application of fluoride varnish |
293 |
293 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
24 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$1K |