| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
732 |
307 |
$674K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,475 |
970 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
834 |
$96K |
| D1110 |
Prophylaxis - adult |
1,470 |
1,470 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,755 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,796 |
1,796 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,852 |
1,852 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
525 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,672 |
2,619 |
$35K |
| D3310 |
|
62 |
46 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,303 |
1,911 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
252 |
231 |
$30K |
| D3320 |
|
66 |
57 |
$26K |
| D1120 |
Prophylaxis - child |
385 |
385 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
30 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
1,474 |
1,463 |
$12K |
| D0330 |
Panoramic radiographic image |
220 |
220 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
735 |
716 |
$10K |
| D2331 |
|
90 |
81 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
575 |
575 |
$8K |
| D2332 |
|
16 |
13 |
$2K |
| D2335 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
110 |
109 |
$2K |
| D2330 |
|
14 |
12 |
$777.20 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$342.00 |