| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
674 |
479 |
$320K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,915 |
1,180 |
$206K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
1,674 |
$87K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
174 |
162 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,300 |
2,294 |
$80K |
| D2950 |
|
584 |
463 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
855 |
554 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,042 |
1,985 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
472 |
372 |
$58K |
| D1110 |
Prophylaxis - adult |
1,288 |
1,284 |
$56K |
| D1120 |
Prophylaxis - child |
1,042 |
1,039 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,057 |
1,995 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,003 |
1,000 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
810 |
807 |
$20K |
| D0274 |
Bitewings - four radiographic images |
675 |
674 |
$19K |
| D0330 |
Panoramic radiographic image |
395 |
394 |
$14K |
| D3320 |
|
27 |
24 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
120 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,097 |
1,009 |
$9K |
| D1206 |
Topical application of fluoride varnish |
181 |
181 |
$5K |
| D1351 |
Sealant - per tooth |
148 |
22 |
$5K |
| D0272 |
Bitewings - two radiographic images |
140 |
140 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$3K |
| D4341 |
|
28 |
12 |
$2K |
| D2332 |
|
16 |
13 |
$2K |
| D7111 |
|
19 |
15 |
$1K |
| D4910 |
|
14 |
14 |
$1K |
| D0270 |
|
12 |
12 |
$101.04 |