| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
5,482 |
3,308 |
$2.39M |
| D2740 |
Crown - porcelain/ceramic |
2,252 |
1,065 |
$660K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
692 |
546 |
$281K |
| D2954 |
|
3,583 |
2,469 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
5,481 |
5,284 |
$226K |
| D1110 |
Prophylaxis - adult |
5,170 |
4,987 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
3,884 |
3,752 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,814 |
1,761 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,852 |
843 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,206 |
4,062 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
4,094 |
3,814 |
$85K |
| D1351 |
Sealant - per tooth |
3,840 |
539 |
$79K |
| D1120 |
Prophylaxis - child |
1,924 |
1,899 |
$66K |
| D2950 |
|
2,328 |
1,149 |
$65K |
| D3320 |
|
223 |
171 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,354 |
3,237 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,045 |
704 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,156 |
2,073 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
766 |
516 |
$31K |
| D0330 |
Panoramic radiographic image |
1,097 |
1,065 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
6,396 |
5,553 |
$25K |
| D1206 |
Topical application of fluoride varnish |
649 |
601 |
$13K |
| D3310 |
|
78 |
42 |
$10K |
| D4355 |
|
126 |
110 |
$9K |
| D2332 |
|
137 |
81 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,046 |
1,043 |
$5K |
| D4910 |
|
39 |
39 |
$2K |
| D0270 |
|
49 |
48 |
$270.48 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$241.84 |