| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
703 |
313 |
$372K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,743 |
596 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,212 |
453 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
525 |
148 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
784 |
769 |
$46K |
| D3310 |
|
95 |
41 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,029 |
1,005 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
370 |
163 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
26 |
$21K |
| D1110 |
Prophylaxis - adult |
516 |
506 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
298 |
50 |
$20K |
| D2332 |
|
133 |
65 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
428 |
418 |
$10K |
| D5110 |
|
13 |
12 |
$8K |
| D1206 |
Topical application of fluoride varnish |
386 |
381 |
$8K |
| D1120 |
Prophylaxis - child |
172 |
169 |
$5K |
| D0274 |
Bitewings - four radiographic images |
119 |
114 |
$3K |
| D2394 |
|
24 |
12 |
$2K |
| D4342 |
|
73 |
19 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
118 |
$1K |
| D2950 |
|
92 |
53 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$1K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$954.95 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$491.56 |