| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,266 |
683 |
$870K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,245 |
474 |
$642K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,430 |
1,528 |
$454K |
| D0330 |
Panoramic radiographic image |
4,449 |
4,276 |
$225K |
| D7230 |
|
930 |
464 |
$212K |
| D2950 |
|
1,179 |
639 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
4,726 |
4,447 |
$161K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
182 |
167 |
$119K |
| D1110 |
Prophylaxis - adult |
2,335 |
2,254 |
$113K |
| D2954 |
|
654 |
468 |
$112K |
| D2335 |
|
770 |
255 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,821 |
1,756 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,108 |
2,043 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
344 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,598 |
1,553 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,510 |
2,310 |
$32K |
| D2394 |
|
318 |
176 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
227 |
124 |
$17K |
| D2332 |
|
139 |
44 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
282 |
280 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,155 |
767 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
57 |
$6K |
| D7311 |
|
18 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$2K |
| D9110 |
|
38 |
35 |
$1K |
| D1999 |
|
15 |
15 |
$0.00 |
| D9450 |
|
384 |
361 |
$0.00 |