| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,047 |
651 |
$1.98M |
| D2783 |
|
326 |
107 |
$222K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
911 |
$165K |
| D2950 |
|
958 |
618 |
$162K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
208 |
194 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,832 |
766 |
$117K |
| D0330 |
Panoramic radiographic image |
2,492 |
2,433 |
$108K |
| D4341 |
|
715 |
286 |
$98K |
| D1110 |
Prophylaxis - adult |
1,953 |
1,927 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,284 |
2,238 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,715 |
1,649 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,473 |
2,431 |
$59K |
| D3320 |
|
116 |
100 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
394 |
289 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
555 |
358 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,117 |
2,950 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,667 |
1,652 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,215 |
1,843 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
58 |
$12K |
| D1120 |
Prophylaxis - child |
294 |
292 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
487 |
484 |
$11K |
| D4910 |
|
130 |
130 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
221 |
$10K |
| D0270 |
|
246 |
238 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$240.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$187.82 |