| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,339 |
1,084 |
$156K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
637 |
609 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
9,867 |
9,306 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,933 |
1,692 |
$103K |
| D2950 |
|
2,121 |
1,758 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
15,784 |
14,773 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,131 |
938 |
$50K |
| D1110 |
Prophylaxis - adult |
1,915 |
1,840 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,708 |
3,628 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,161 |
2,042 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
2,441 |
2,372 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,927 |
1,842 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,883 |
3,693 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,050 |
981 |
$12K |
| D1120 |
Prophylaxis - child |
848 |
833 |
$11K |
| D0350 |
|
1,097 |
1,038 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
121 |
$4K |
| D7240 |
Removal of impacted tooth - completely bony |
32 |
13 |
$4K |
| D3320 |
|
27 |
25 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
38 |
$2K |
| D0272 |
Bitewings - two radiographic images |
188 |
186 |
$1K |
| D2931 |
|
15 |
14 |
$1K |
| D1999 |
|
1,185 |
1,022 |
$172.50 |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$147.81 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$59.42 |
| D0602 |
|
59 |
57 |
$0.00 |
| D0603 |
|
38 |
13 |
$0.00 |
| D9215 |
|
19 |
18 |
$0.00 |