| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
478 |
331 |
$286K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,067 |
404 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,116 |
615 |
$120K |
| D1110 |
Prophylaxis - adult |
2,282 |
2,270 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,121 |
2,058 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,375 |
1,339 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,643 |
1,634 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,832 |
$48K |
| D2950 |
|
335 |
262 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,470 |
2,365 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,132 |
1,125 |
$33K |
| D1120 |
Prophylaxis - child |
816 |
811 |
$33K |
| D4341 |
|
223 |
65 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
177 |
121 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,389 |
1,368 |
$18K |
| D0330 |
Panoramic radiographic image |
365 |
358 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
649 |
644 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
77 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$8K |
| D1206 |
Topical application of fluoride varnish |
209 |
209 |
$5K |
| D4355 |
|
55 |
55 |
$5K |
| D7250 |
|
53 |
15 |
$4K |
| D1351 |
Sealant - per tooth |
75 |
12 |
$2K |
| D2331 |
|
19 |
12 |
$1K |
| D0180 |
|
28 |
28 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$248.11 |
| D0270 |
|
13 |
13 |
$176.92 |
| D0603 |
|
21 |
19 |
$0.00 |