| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
299 |
143 |
$221K |
| D1110 |
Prophylaxis - adult |
6,246 |
5,903 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,249 |
1,870 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
1,967 |
1,854 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
6,078 |
5,734 |
$106K |
| D2931 |
|
951 |
730 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,930 |
784 |
$100K |
| D0274 |
Bitewings - four radiographic images |
4,295 |
4,036 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,435 |
2,246 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,234 |
798 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,875 |
1,694 |
$45K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
114 |
107 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
593 |
406 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,939 |
1,856 |
$29K |
| D1120 |
Prophylaxis - child |
1,226 |
1,188 |
$24K |
| D1321 |
|
585 |
505 |
$17K |
| D1351 |
Sealant - per tooth |
495 |
115 |
$11K |
| D0330 |
Panoramic radiographic image |
238 |
227 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
70 |
42 |
$4K |
| D0272 |
Bitewings - two radiographic images |
307 |
304 |
$3K |
| D2331 |
|
20 |
12 |
$885.86 |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
82 |
$540.71 |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
57 |
$275.50 |