| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
300 |
160 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,389 |
616 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,152 |
551 |
$75K |
| D0330 |
Panoramic radiographic image |
1,341 |
1,218 |
$58K |
| D2394 |
|
663 |
324 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,611 |
1,515 |
$39K |
| D1110 |
Prophylaxis - adult |
894 |
828 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,274 |
1,156 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
652 |
564 |
$21K |
| D1120 |
Prophylaxis - child |
334 |
321 |
$14K |
| D2335 |
|
177 |
71 |
$13K |
| D2950 |
|
116 |
53 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,155 |
994 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
365 |
353 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
45 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
130 |
117 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
43 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
737 |
285 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
102 |
$2K |
| D2954 |
|
16 |
12 |
$2K |
| D2332 |
|
26 |
12 |
$1K |
| D9986 |
|
215 |
193 |
$579.00 |
| D1999 |
|
25 |
21 |
$0.00 |
| D9215 |
|
706 |
529 |
$0.00 |