| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
393 |
261 |
$184K |
| D9430 |
|
1,856 |
1,612 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
963 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
874 |
858 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
157 |
$19K |
| D4341 |
|
269 |
73 |
$19K |
| D2952 |
|
102 |
80 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
98 |
$9K |
| D4910 |
|
117 |
117 |
$9K |
| D1110 |
Prophylaxis - adult |
136 |
133 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,892 |
931 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
50 |
$8K |
| D2330 |
|
90 |
38 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2954 |
|
53 |
28 |
$6K |
| D0350 |
|
347 |
225 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
236 |
224 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
50 |
50 |
$3K |
| D0270 |
|
323 |
292 |
$2K |
| D1206 |
Topical application of fluoride varnish |
69 |
66 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$194.40 |
| D1999 |
|
60 |
57 |
$0.00 |