| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,369 |
2,825 |
$1.78M |
| D2954 |
|
1,671 |
1,561 |
$236K |
| D1110 |
Prophylaxis - adult |
4,059 |
4,059 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,181 |
1,649 |
$203K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
374 |
361 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
4,147 |
4,147 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
3,509 |
3,496 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,424 |
3,424 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
5,831 |
5,814 |
$77K |
| D1120 |
Prophylaxis - child |
1,549 |
1,549 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,794 |
1,794 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
3,347 |
3,271 |
$45K |
| D0350 |
|
2,963 |
2,963 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
273 |
232 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,750 |
1,750 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
311 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,324 |
2,324 |
$21K |
| D0270 |
|
1,055 |
1,051 |
$14K |
| D0272 |
Bitewings - two radiographic images |
738 |
737 |
$12K |
| D4342 |
|
364 |
155 |
$11K |
| D3320 |
|
25 |
24 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
61 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
105 |
$7K |
| D1206 |
Topical application of fluoride varnish |
203 |
203 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
36 |
$5K |
| D0330 |
Panoramic radiographic image |
212 |
212 |
$5K |
| D9995 |
|
232 |
218 |
$5K |
| D2335 |
|
12 |
12 |
$3K |
| D9996 |
|
216 |
210 |
$2K |
| D4910 |
|
14 |
14 |
$763.28 |
| D1999 |
|
2,047 |
1,795 |
$0.00 |
| D0170 |
|
76 |
73 |
$0.00 |