| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,461 |
1,677 |
$1.17M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,879 |
3,245 |
$390K |
| D1110 |
Prophylaxis - adult |
3,808 |
3,772 |
$331K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,279 |
4,239 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
3,026 |
2,992 |
$245K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,939 |
1,925 |
$231K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
493 |
462 |
$228K |
| D2330 |
|
2,809 |
1,283 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,609 |
2,031 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
3,224 |
3,196 |
$154K |
| D2954 |
|
1,157 |
853 |
$121K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
204 |
144 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,603 |
620 |
$91K |
| D1120 |
Prophylaxis - child |
2,046 |
2,014 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,399 |
4,216 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,321 |
6,244 |
$87K |
| D9430 |
|
2,443 |
2,334 |
$78K |
| D3320 |
|
156 |
122 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,502 |
2,471 |
$53K |
| D3310 |
|
159 |
107 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,403 |
3,229 |
$41K |
| D0350 |
|
2,101 |
854 |
$21K |
| D1351 |
Sealant - per tooth |
260 |
70 |
$8K |
| D2931 |
|
40 |
30 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
24 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D2394 |
|
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |
| D1330 |
|
18 |
18 |
$0.00 |