| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,059 |
1,352 |
$1.45M |
| D1110 |
Prophylaxis - adult |
5,570 |
5,441 |
$293K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,837 |
1,204 |
$250K |
| D2950 |
|
1,279 |
1,031 |
$203K |
| D0210 |
Intraoral - complete series of radiographic images |
2,666 |
2,589 |
$188K |
| D3320 |
|
311 |
277 |
$171K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
315 |
194 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,379 |
1,000 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
3,790 |
3,657 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,925 |
3,852 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,347 |
1,143 |
$137K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
170 |
156 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,440 |
880 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,730 |
2,641 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,235 |
4,146 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,530 |
5,227 |
$82K |
| D3310 |
|
145 |
96 |
$64K |
| D1120 |
Prophylaxis - child |
1,073 |
1,045 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,928 |
2,403 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,154 |
1,129 |
$34K |
| D5212 |
|
36 |
36 |
$19K |
| D2330 |
|
228 |
86 |
$15K |
| D5211 |
|
26 |
26 |
$13K |
| D0330 |
Panoramic radiographic image |
115 |
112 |
$7K |
| D2332 |
|
56 |
28 |
$6K |
| D2954 |
|
34 |
22 |
$6K |
| D2331 |
|
66 |
39 |
$5K |
| D1351 |
Sealant - per tooth |
111 |
27 |
$5K |
| D4341 |
|
31 |
14 |
$4K |
| D1206 |
Topical application of fluoride varnish |
116 |
112 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$2K |
| D7311 |
|
16 |
13 |
$2K |
| D3120 |
|
19 |
13 |
$658.00 |
| D0270 |
|
14 |
14 |
$186.00 |