| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
881 |
433 |
$589K |
| D2335 |
|
2,653 |
924 |
$476K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,083 |
946 |
$342K |
| D4342 |
|
2,927 |
983 |
$261K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
327 |
273 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
816 |
482 |
$110K |
| D2950 |
|
723 |
374 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,042 |
1,031 |
$81K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
99 |
93 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,684 |
4,587 |
$57K |
| D2332 |
|
308 |
185 |
$47K |
| D0180 |
|
1,045 |
1,042 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,246 |
1,231 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,161 |
2,125 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,062 |
1,060 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
745 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,129 |
1,125 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
166 |
95 |
$25K |
| D4910 |
|
346 |
346 |
$25K |
| D1110 |
Prophylaxis - adult |
430 |
430 |
$18K |
| D2954 |
|
98 |
73 |
$16K |
| D0460 |
|
399 |
385 |
$10K |
| D2394 |
|
31 |
24 |
$6K |
| D0160 |
|
86 |
75 |
$6K |
| D9310 |
|
88 |
88 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$825.99 |
| D0270 |
|
12 |
12 |
$165.48 |