| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
748 |
421 |
$187K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,581 |
$47K |
| D2950 |
|
773 |
447 |
$44K |
| D4355 |
|
585 |
574 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,596 |
1,399 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
53 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
551 |
320 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,391 |
1,315 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
260 |
133 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,785 |
2,263 |
$19K |
| D9610 |
|
1,482 |
1,271 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,305 |
1,267 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,520 |
1,276 |
$14K |
| D4910 |
|
334 |
329 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
1,190 |
499 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
429 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
27 |
$5K |
| D3320 |
|
14 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
480 |
473 |
$4K |
| D1120 |
Prophylaxis - child |
252 |
246 |
$3K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$1K |
| D9630 |
|
327 |
326 |
$723.24 |