| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
876 |
573 |
$599K |
| D2950 |
|
719 |
497 |
$112K |
| D1110 |
Prophylaxis - adult |
1,843 |
1,794 |
$97K |
| D0330 |
Panoramic radiographic image |
1,235 |
1,195 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
470 |
225 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
1,018 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,573 |
1,541 |
$45K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
48 |
45 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,305 |
1,282 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
572 |
550 |
$23K |
| D3320 |
|
40 |
27 |
$21K |
| D1120 |
Prophylaxis - child |
294 |
287 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
479 |
468 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
83 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
629 |
602 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
37 |
$8K |
| D0272 |
Bitewings - two radiographic images |
311 |
304 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
41 |
$5K |
| D1351 |
Sealant - per tooth |
116 |
26 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$3K |
| D2954 |
|
15 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
25 |
$300.00 |