| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
558 |
378 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,728 |
663 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,781 |
1,737 |
$44K |
| D0330 |
Panoramic radiographic image |
1,662 |
1,621 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,078 |
1,059 |
$26K |
| D1110 |
Prophylaxis - adult |
838 |
824 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
425 |
244 |
$23K |
| D2950 |
|
410 |
286 |
$21K |
| D1120 |
Prophylaxis - child |
727 |
716 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,569 |
1,534 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
600 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
351 |
165 |
$15K |
| D4341 |
|
253 |
80 |
$12K |
| D1206 |
Topical application of fluoride varnish |
524 |
512 |
$10K |
| D0274 |
Bitewings - four radiographic images |
957 |
938 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
210 |
210 |
$6K |
| D1351 |
Sealant - per tooth |
418 |
53 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,293 |
1,209 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,122 |
969 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$4K |
| D2954 |
|
52 |
38 |
$2K |
| D4910 |
|
28 |
27 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$918.00 |