| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,344 |
703 |
$936K |
| D2950 |
|
1,208 |
689 |
$192K |
| D1110 |
Prophylaxis - adult |
1,624 |
1,592 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
426 |
270 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
667 |
337 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,297 |
1,264 |
$55K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
76 |
70 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,375 |
1,275 |
$51K |
| D0330 |
Panoramic radiographic image |
1,009 |
956 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,139 |
1,112 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
157 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
784 |
779 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,289 |
1,204 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
211 |
207 |
$15K |
| D1120 |
Prophylaxis - child |
270 |
269 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
480 |
476 |
$14K |
| D0180 |
|
167 |
167 |
$6K |
| D4341 |
|
38 |
12 |
$5K |
| D9110 |
|
100 |
79 |
$3K |
| D1351 |
Sealant - per tooth |
64 |
15 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
144 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$950.00 |