| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
4,618 |
2,156 |
$2.97M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12,228 |
6,140 |
$1.93M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,477 |
6,842 |
$1.91M |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,745 |
9,686 |
$439K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,489 |
1,496 |
$423K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,957 |
7,929 |
$316K |
| D2950 |
|
2,491 |
1,926 |
$315K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,949 |
968 |
$305K |
| D0140 |
Limited oral evaluation - problem focused |
5,317 |
5,246 |
$184K |
| D0220 |
Intraoral - periapical first radiographic image |
14,409 |
14,208 |
$177K |
| D4342 |
|
1,518 |
779 |
$148K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,077 |
521 |
$109K |
| D0330 |
Panoramic radiographic image |
1,930 |
1,928 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
8,494 |
8,409 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
798 |
462 |
$83K |
| D2394 |
|
411 |
303 |
$77K |
| D1110 |
Prophylaxis - adult |
1,565 |
1,551 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,921 |
2,906 |
$68K |
| D3320 |
|
99 |
80 |
$55K |
| D2331 |
|
438 |
302 |
$52K |
| D2332 |
|
217 |
157 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,078 |
1,070 |
$31K |
| D2160 |
|
278 |
156 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
29 |
$26K |
| D2335 |
|
143 |
70 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
30 |
24 |
$13K |
| D2954 |
|
53 |
24 |
$9K |
| D4341 |
|
39 |
26 |
$7K |
| D2140 |
|
27 |
14 |
$2K |