| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,897 |
1,615 |
$1.82M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,506 |
1,209 |
$936K |
| D1110 |
Prophylaxis - adult |
6,838 |
6,208 |
$331K |
| D2954 |
|
1,918 |
1,138 |
$306K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
428 |
255 |
$228K |
| D0210 |
Intraoral - complete series of radiographic images |
2,477 |
2,262 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,891 |
1,067 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,079 |
3,741 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
5,888 |
5,405 |
$125K |
| D3320 |
|
217 |
183 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
2,615 |
2,388 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,291 |
662 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,696 |
1,626 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,218 |
3,889 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,826 |
1,760 |
$50K |
| D4342 |
|
595 |
219 |
$46K |
| D1120 |
Prophylaxis - child |
757 |
736 |
$36K |
| D2950 |
|
195 |
156 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
141 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
172 |
112 |
$16K |
| D3310 |
|
20 |
12 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
707 |
585 |
$9K |
| D4341 |
|
71 |
25 |
$8K |
| D5212 |
|
13 |
13 |
$7K |
| D5211 |
|
12 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
136 |
39 |
$5K |
| D0270 |
|
270 |
247 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
14 |
$2K |
| D2330 |
|
20 |
14 |
$1K |
| D0180 |
|
38 |
29 |
$558.00 |