| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
327 |
216 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
978 |
619 |
$83K |
| D1110 |
Prophylaxis - adult |
1,437 |
1,423 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
694 |
365 |
$57K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
101 |
95 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,500 |
1,483 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,538 |
1,525 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,196 |
1,142 |
$43K |
| D0330 |
Panoramic radiographic image |
528 |
523 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
401 |
309 |
$37K |
| D2954 |
|
114 |
94 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
492 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
123 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,105 |
2,001 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
649 |
644 |
$17K |
| D1120 |
Prophylaxis - child |
312 |
312 |
$11K |
| D2394 |
|
97 |
75 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
785 |
467 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$923.48 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$353.70 |