| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,528 |
957 |
$1.03M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
576 |
493 |
$410K |
| D2950 |
|
759 |
500 |
$119K |
| D1110 |
Prophylaxis - adult |
2,289 |
2,143 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
637 |
287 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,273 |
4,472 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,006 |
1,775 |
$69K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
104 |
71 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
351 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
880 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,559 |
1,458 |
$32K |
| D2954 |
|
169 |
133 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
430 |
395 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,998 |
1,610 |
$24K |
| D0274 |
Bitewings - four radiographic images |
713 |
654 |
$22K |
| D4342 |
|
199 |
86 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
95 |
$9K |
| D3320 |
|
13 |
12 |
$7K |
| D0270 |
|
600 |
522 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
46 |
$4K |
| D0330 |
Panoramic radiographic image |
63 |
61 |
$4K |
| D9110 |
|
68 |
67 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$403.00 |