| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
150 |
99 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,341 |
594 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,250 |
513 |
$82K |
| D1110 |
Prophylaxis - adult |
2,101 |
1,996 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,028 |
971 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,715 |
1,632 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
362 |
153 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,432 |
1,375 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,219 |
1,165 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
111 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
577 |
541 |
$21K |
| D1120 |
Prophylaxis - child |
763 |
738 |
$19K |
| D1206 |
Topical application of fluoride varnish |
546 |
532 |
$12K |
| D9944 |
|
84 |
81 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$11K |
| D2950 |
|
70 |
46 |
$10K |
| D2335 |
|
45 |
24 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
673 |
$7K |
| D0272 |
Bitewings - two radiographic images |
316 |
308 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
418 |
215 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
273 |
262 |
$4K |
| D1321 |
|
317 |
300 |
$3K |
| D1320 |
|
297 |
280 |
$3K |
| D2330 |
|
28 |
15 |
$3K |
| D1351 |
Sealant - per tooth |
69 |
14 |
$3K |
| D4342 |
|
50 |
12 |
$2K |
| T1015 |
Clinic visit/encounter, all-inclusive |
15 |
12 |
$0.00 |