| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
750 |
424 |
$459K |
| D1110 |
Prophylaxis - adult |
1,823 |
1,729 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,234 |
2,102 |
$55K |
| D1120 |
Prophylaxis - child |
787 |
734 |
$38K |
| D0274 |
Bitewings - four radiographic images |
886 |
855 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,915 |
1,770 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
761 |
695 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
33 |
28 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
201 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
277 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
453 |
$20K |
| D2950 |
|
116 |
80 |
$17K |
| D1206 |
Topical application of fluoride varnish |
653 |
607 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
101 |
50 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,114 |
924 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
70 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
114 |
110 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$910.00 |
| D0272 |
Bitewings - two radiographic images |
18 |
15 |
$432.00 |