| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
864 |
458 |
$546K |
| D1110 |
Prophylaxis - adult |
3,668 |
3,494 |
$190K |
| D0274 |
Bitewings - four radiographic images |
3,525 |
3,378 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,377 |
3,222 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
982 |
533 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
736 |
414 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
3,829 |
3,586 |
$58K |
| D2950 |
|
393 |
249 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,228 |
2,926 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,124 |
1,031 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
63 |
51 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
441 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,115 |
1,093 |
$32K |
| D0330 |
Panoramic radiographic image |
524 |
516 |
$29K |
| D1120 |
Prophylaxis - child |
585 |
583 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
640 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
19 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
41 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
60 |
$8K |
| D2394 |
|
45 |
29 |
$5K |
| D0180 |
|
22 |
22 |
$982.00 |