| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,544 |
769 |
$1.00M |
| D1110 |
Prophylaxis - adult |
5,182 |
4,896 |
$259K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,455 |
1,624 |
$215K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
309 |
163 |
$170K |
| D2394 |
|
1,432 |
971 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,946 |
1,256 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
3,948 |
3,499 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,246 |
4,955 |
$117K |
| D2954 |
|
655 |
410 |
$112K |
| D0330 |
Panoramic radiographic image |
1,642 |
1,526 |
$103K |
| D2332 |
|
934 |
459 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,039 |
654 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,913 |
1,813 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,220 |
2,096 |
$61K |
| D1120 |
Prophylaxis - child |
1,196 |
1,139 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
93 |
57 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
2,954 |
2,588 |
$40K |
| D9110 |
|
949 |
834 |
$33K |
| D2335 |
|
253 |
135 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
700 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
83 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
230 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
685 |
574 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
45 |
$5K |
| D4341 |
|
34 |
12 |
$4K |
| D0180 |
|
51 |
41 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$434.00 |