| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
562 |
452 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,967 |
3,936 |
$258K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,185 |
7,356 |
$150K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
290 |
271 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
805 |
490 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
1,326 |
1,319 |
$78K |
| D2954 |
|
388 |
331 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,291 |
3,283 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,768 |
1,746 |
$37K |
| D1120 |
Prophylaxis - child |
900 |
896 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
234 |
$30K |
| D9430 |
|
926 |
910 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,098 |
2,077 |
$26K |
| D1110 |
Prophylaxis - adult |
294 |
290 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
239 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
904 |
$11K |
| D3320 |
|
30 |
27 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
41 |
$6K |
| D4910 |
|
36 |
36 |
$3K |
| D0350 |
|
276 |
136 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$840.00 |
| D0270 |
|
29 |
29 |
$145.00 |