| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
316 |
260 |
$198K |
| D1110 |
Prophylaxis - adult |
5,077 |
5,058 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,497 |
1,268 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,489 |
1,224 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,502 |
4,486 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,628 |
2,575 |
$73K |
| D2950 |
|
420 |
363 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,940 |
4,470 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,101 |
2,092 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,327 |
1,324 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
365 |
361 |
$26K |
| D1120 |
Prophylaxis - child |
563 |
562 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,319 |
1,920 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
25 |
$16K |
| D4341 |
|
113 |
55 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
595 |
594 |
$15K |
| D2394 |
|
152 |
136 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
42 |
$4K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$871.97 |
| D1999 |
|
227 |
179 |
$0.00 |