| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
562 |
340 |
$387K |
| D1110 |
Prophylaxis - adult |
3,755 |
3,661 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
4,203 |
4,095 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,582 |
2,511 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
3,653 |
3,501 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,610 |
2,487 |
$35K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
49 |
39 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,070 |
1,037 |
$31K |
| D1120 |
Prophylaxis - child |
605 |
590 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
545 |
$22K |
| D2950 |
|
115 |
86 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
146 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
97 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
152 |
151 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
213 |
$10K |
| D2954 |
|
37 |
28 |
$7K |
| D0330 |
Panoramic radiographic image |
135 |
131 |
$7K |
| D4341 |
|
27 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
56 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$330.00 |