| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
404 |
327 |
$192K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,241 |
2,232 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,156 |
2,147 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
673 |
669 |
$45K |
| D4341 |
|
636 |
187 |
$45K |
| D1110 |
Prophylaxis - adult |
402 |
402 |
$35K |
| D2954 |
|
294 |
238 |
$31K |
| D4910 |
|
293 |
292 |
$22K |
| D0274 |
Bitewings - four radiographic images |
633 |
627 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
187 |
123 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$13K |
| D9430 |
|
376 |
362 |
$12K |
| D1206 |
Topical application of fluoride varnish |
509 |
508 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,899 |
995 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
39 |
$5K |
| D1120 |
Prophylaxis - child |
92 |
92 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
232 |
228 |
$3K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$392.00 |
| D0350 |
|
19 |
12 |
$182.40 |