| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,614 |
989 |
$1.82M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
547 |
441 |
$386K |
| D1110 |
Prophylaxis - adult |
4,246 |
4,120 |
$229K |
| D2950 |
|
1,172 |
787 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,977 |
2,844 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,909 |
2,859 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,300 |
737 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,546 |
820 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,446 |
3,406 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,211 |
1,143 |
$82K |
| D1120 |
Prophylaxis - child |
1,546 |
1,537 |
$80K |
| D3320 |
|
138 |
99 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,106 |
2,090 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,525 |
1,461 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,290 |
3,100 |
$49K |
| D1351 |
Sealant - per tooth |
812 |
181 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,419 |
2,055 |
$29K |
| D3310 |
|
60 |
27 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
320 |
164 |
$25K |
| D0330 |
Panoramic radiographic image |
409 |
395 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$8K |
| D2954 |
|
37 |
24 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
29 |
$5K |
| D0272 |
Bitewings - two radiographic images |
149 |
148 |
$5K |
| D4342 |
|
34 |
13 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$308.00 |
| D1330 |
|
34 |
29 |
$0.00 |