| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
448 |
296 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,005 |
585 |
$136K |
| D0330 |
Panoramic radiographic image |
2,054 |
2,053 |
$109K |
| D0350 |
|
800 |
769 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
921 |
457 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
489 |
321 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,774 |
1,735 |
$65K |
| D1110 |
Prophylaxis - adult |
1,283 |
1,282 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,444 |
$61K |
| D2950 |
|
446 |
317 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,426 |
1,426 |
$43K |
| D4342 |
|
403 |
132 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,062 |
1,061 |
$27K |
| D4910 |
|
277 |
275 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
501 |
500 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
40 |
$18K |
| D4341 |
|
59 |
24 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
83 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
778 |
774 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
27 |
$8K |
| D1206 |
Topical application of fluoride varnish |
317 |
317 |
$7K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$1K |
| D0460 |
|
12 |
12 |
$331.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$287.02 |