| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
653 |
437 |
$385K |
| D0120 |
Periodic oral evaluation - established patient |
7,944 |
7,908 |
$185K |
| D0140 |
Limited oral evaluation - problem focused |
6,120 |
5,997 |
$182K |
| D1110 |
Prophylaxis - adult |
3,480 |
3,472 |
$160K |
| D4355 |
|
2,236 |
2,218 |
$138K |
| D2950 |
|
717 |
570 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
9,220 |
8,946 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
2,112 |
2,043 |
$99K |
| D1120 |
Prophylaxis - child |
2,058 |
2,054 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,141 |
3,139 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,180 |
3,161 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,138 |
2,126 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
929 |
564 |
$67K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
112 |
110 |
$64K |
| D0330 |
Panoramic radiographic image |
1,060 |
1,056 |
$54K |
| D2394 |
|
542 |
506 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,718 |
5,211 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,559 |
1,558 |
$35K |
| D3320 |
|
74 |
66 |
$33K |
| D3310 |
|
41 |
30 |
$18K |
| D2752 |
|
26 |
17 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
163 |
$13K |
| D2792 |
|
18 |
14 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
79 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
42 |
$4K |
| D2335 |
|
32 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
26 |
$3K |
| D0270 |
|
251 |
246 |
$2K |
| D2920 |
|
29 |
27 |
$962.07 |
| D6930 |
|
13 |
13 |
$526.69 |