| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
123 |
94 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
398 |
209 |
$49K |
| D4341 |
|
238 |
102 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
277 |
141 |
$29K |
| D1110 |
Prophylaxis - adult |
261 |
251 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$14K |
| D2950 |
|
120 |
90 |
$14K |
| D1206 |
Topical application of fluoride varnish |
453 |
440 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
167 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
140 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
35 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
79 |
$7K |
| D4910 |
|
69 |
65 |
$7K |
| D1120 |
Prophylaxis - child |
101 |
99 |
$5K |
| D2940 |
|
97 |
62 |
$5K |
| D3120 |
|
76 |
55 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
125 |
$3K |
| D0330 |
Panoramic radiographic image |
39 |
38 |
$2K |
| D2330 |
|
25 |
13 |
$2K |
| D0460 |
|
69 |
43 |
$2K |
| D0274 |
Bitewings - four radiographic images |
31 |
29 |
$1K |
| D4346 |
|
12 |
12 |
$815.28 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
13 |
$451.10 |