| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
2,029 |
814 |
$199K |
| D2740 |
Crown - porcelain/ceramic |
232 |
151 |
$175K |
| D0330 |
Panoramic radiographic image |
1,337 |
1,335 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
241 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
176 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,057 |
1,052 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
353 |
103 |
$37K |
| D1110 |
Prophylaxis - adult |
748 |
747 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,181 |
1,177 |
$34K |
| D2950 |
|
245 |
151 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
188 |
118 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
885 |
870 |
$30K |
| D4341 |
|
76 |
38 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
17 |
$20K |
| D2332 |
|
101 |
60 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,095 |
1,078 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
57 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
502 |
487 |
$9K |
| D2394 |
|
42 |
28 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
344 |
343 |
$7K |
| D0460 |
|
180 |
179 |
$5K |
| D0180 |
|
118 |
118 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
122 |
120 |
$3K |