| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
291 |
138 |
$237K |
| D1110 |
Prophylaxis - adult |
2,524 |
2,462 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
907 |
869 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
520 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,336 |
3,291 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
629 |
259 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,248 |
2,216 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,246 |
1,193 |
$34K |
| D0330 |
Panoramic radiographic image |
597 |
585 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
276 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
810 |
796 |
$28K |
| D1120 |
Prophylaxis - child |
1,104 |
1,091 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,276 |
1,258 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,801 |
3,646 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,041 |
2,743 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
104 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
63 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
144 |
79 |
$8K |
| D2160 |
|
69 |
44 |
$4K |
| D2950 |
|
19 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
105 |
104 |
$1K |
| D2140 |
|
21 |
15 |
$840.00 |
| D0180 |
|
14 |
14 |
$704.90 |
| D0270 |
|
18 |
18 |
$90.00 |