| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,161 |
1,284 |
$1.93M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,866 |
1,529 |
$809K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,159 |
1,170 |
$702K |
| D2950 |
|
3,208 |
1,360 |
$425K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,226 |
1,045 |
$360K |
| D4342 |
|
2,942 |
969 |
$303K |
| D0330 |
Panoramic radiographic image |
3,018 |
3,016 |
$160K |
| D3320 |
|
231 |
168 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,248 |
388 |
$131K |
| D0350 |
|
3,058 |
2,677 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
2,892 |
2,745 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,462 |
2,458 |
$105K |
| D1110 |
Prophylaxis - adult |
1,941 |
1,930 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,045 |
3,038 |
$92K |
| D4341 |
|
270 |
93 |
$64K |
| D2330 |
|
597 |
154 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,895 |
1,883 |
$49K |
| D0460 |
|
1,357 |
1,177 |
$37K |
| D4910 |
|
343 |
341 |
$31K |
| D2394 |
|
150 |
86 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,840 |
1,670 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,025 |
1,023 |
$22K |
| D3310 |
|
56 |
27 |
$19K |
| D1120 |
Prophylaxis - child |
286 |
284 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
299 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
398 |
392 |
$5K |
| D2335 |
|
22 |
13 |
$4K |