| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
963 |
637 |
$668K |
| D1110 |
Prophylaxis - adult |
5,227 |
5,149 |
$279K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
461 |
189 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
5,156 |
5,098 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
3,011 |
2,840 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
5,022 |
4,856 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
815 |
576 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,464 |
1,449 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
327 |
202 |
$43K |
| D2335 |
|
264 |
87 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,345 |
1,782 |
$30K |
| D2950 |
|
155 |
140 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
24 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
218 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
123 |
$14K |
| D2394 |
|
140 |
85 |
$14K |
| D7311 |
|
138 |
107 |
$12K |
| D2954 |
|
49 |
40 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
50 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$2K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D9110 |
|
15 |
14 |
$537.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$392.00 |
| D1999 |
|
318 |
269 |
$0.00 |