| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
949 |
565 |
$451K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,638 |
2,624 |
$168K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
358 |
295 |
$164K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,316 |
609 |
$154K |
| D1110 |
Prophylaxis - adult |
1,755 |
1,733 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
2,536 |
2,513 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,812 |
913 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
2,392 |
2,377 |
$109K |
| D1120 |
Prophylaxis - child |
2,385 |
2,361 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,255 |
2,231 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,959 |
2,926 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
613 |
338 |
$33K |
| D3320 |
|
31 |
25 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
76 |
$8K |
| D4341 |
|
54 |
14 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
827 |
494 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
13 |
$3K |
| D9430 |
|
69 |
68 |
$2K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
52 |
52 |
$600.00 |
| D0270 |
|
26 |
26 |
$130.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$30.00 |