| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,447 |
883 |
$1.01M |
| D1110 |
Prophylaxis - adult |
8,131 |
8,010 |
$416K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,934 |
936 |
$265K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
420 |
310 |
$235K |
| D2950 |
|
1,473 |
1,036 |
$228K |
| D0210 |
Intraoral - complete series of radiographic images |
2,465 |
2,418 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
2,830 |
2,766 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,987 |
4,926 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
2,361 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,225 |
725 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,028 |
2,005 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,027 |
629 |
$57K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
88 |
79 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,545 |
2,481 |
$36K |
| D1206 |
Topical application of fluoride varnish |
297 |
296 |
$8K |
| D0330 |
Panoramic radiographic image |
106 |
103 |
$7K |
| D3320 |
|
14 |
12 |
$5K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
160 |
131 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D2331 |
|
15 |
12 |
$1K |
| D0270 |
|
72 |
72 |
$895.00 |