| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,023 |
539 |
$215K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,454 |
663 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,670 |
797 |
$94K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
269 |
230 |
$71K |
| D1110 |
Prophylaxis - adult |
2,218 |
2,198 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,001 |
876 |
$36K |
| D2332 |
|
484 |
189 |
$28K |
| D2954 |
|
358 |
230 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,012 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
381 |
193 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,513 |
1,502 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
818 |
770 |
$12K |
| D0274 |
Bitewings - four radiographic images |
699 |
692 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,943 |
1,736 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,705 |
947 |
$11K |
| D3320 |
|
119 |
96 |
$10K |
| D2950 |
|
407 |
244 |
$7K |
| D2335 |
|
205 |
98 |
$6K |
| D1206 |
Topical application of fluoride varnish |
340 |
340 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
43 |
$3K |
| D2331 |
|
22 |
12 |
$2K |
| D9920 |
|
22 |
19 |
$2K |
| D1120 |
Prophylaxis - child |
84 |
84 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$312.24 |
| D9994 |
|
93 |
93 |
$0.00 |
| D9630 |
|
368 |
364 |
$0.00 |
| D9610 |
|
364 |
362 |
$0.00 |
| D7880 |
|
12 |
12 |
$0.00 |