| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
482 |
352 |
$250K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
267 |
241 |
$175K |
| D1110 |
Prophylaxis - adult |
1,739 |
1,713 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
925 |
585 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,630 |
1,611 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,927 |
1,901 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,546 |
1,528 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,153 |
1,134 |
$33K |
| D2950 |
|
301 |
236 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
344 |
234 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,353 |
2,235 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
756 |
740 |
$17K |
| D3320 |
|
31 |
27 |
$16K |
| D1120 |
Prophylaxis - child |
475 |
472 |
$16K |
| D3310 |
|
28 |
12 |
$13K |
| D0330 |
Panoramic radiographic image |
311 |
302 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
179 |
118 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
524 |
523 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,004 |
539 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$205.81 |