| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
391 |
275 |
$248K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
138 |
132 |
$83K |
| D2950 |
|
483 |
352 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
260 |
$58K |
| D5214 |
|
53 |
53 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
425 |
414 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
630 |
$27K |
| D2790 |
|
34 |
28 |
$22K |
| D1110 |
Prophylaxis - adult |
400 |
400 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
467 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
46 |
$11K |
| D5213 |
|
12 |
12 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
629 |
591 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
78 |
$9K |
| D3320 |
|
16 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
641 |
540 |
$6K |
| D0274 |
Bitewings - four radiographic images |
148 |
148 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
19 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
123 |
123 |
$3K |
| D2332 |
|
22 |
16 |
$3K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$3K |
| D1351 |
Sealant - per tooth |
65 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$846.83 |