| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
288 |
178 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,281 |
500 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
920 |
515 |
$123K |
| D0330 |
Panoramic radiographic image |
1,781 |
1,778 |
$95K |
| D1110 |
Prophylaxis - adult |
1,461 |
1,455 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
415 |
189 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,505 |
1,503 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,498 |
1,496 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,096 |
1,065 |
$41K |
| D2950 |
|
269 |
204 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
111 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,004 |
1,001 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
415 |
413 |
$23K |
| D0350 |
|
203 |
120 |
$15K |
| D4342 |
|
149 |
51 |
$14K |
| D4910 |
|
143 |
142 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
809 |
793 |
$11K |
| D4341 |
|
37 |
13 |
$10K |
| D0382 |
|
46 |
46 |
$7K |
| D3320 |
|
15 |
12 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0381 |
|
28 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |
| D0460 |
|
100 |
93 |
$3K |
| D2330 |
|
29 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$420.81 |