| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
350 |
185 |
$218K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
524 |
234 |
$87K |
| D0330 |
Panoramic radiographic image |
1,229 |
1,229 |
$67K |
| D0350 |
|
1,210 |
1,064 |
$50K |
| D0460 |
|
1,750 |
1,563 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,190 |
1,129 |
$46K |
| D1110 |
Prophylaxis - adult |
739 |
736 |
$43K |
| D2394 |
|
184 |
102 |
$37K |
| D2950 |
|
277 |
162 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
775 |
773 |
$35K |
| D0274 |
Bitewings - four radiographic images |
657 |
653 |
$20K |
| D4341 |
|
60 |
25 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
14 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
135 |
134 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
162 |
$2K |
| D0381 |
|
12 |
12 |
$2K |
| D0382 |
|
12 |
12 |
$2K |