| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,232 |
315 |
$687K |
| D1110 |
Prophylaxis - adult |
4,209 |
3,881 |
$198K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
339 |
109 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,529 |
703 |
$109K |
| D0274 |
Bitewings - four radiographic images |
3,325 |
3,075 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,453 |
3,181 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,070 |
951 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
732 |
246 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,332 |
3,827 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
231 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,133 |
3,198 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,250 |
1,120 |
$45K |
| D4341 |
|
440 |
100 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,085 |
983 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
651 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
72 |
$25K |
| D2950 |
|
181 |
109 |
$25K |
| D7311 |
|
142 |
70 |
$12K |
| D1120 |
Prophylaxis - child |
215 |
198 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
13 |
$9K |
| D0330 |
Panoramic radiographic image |
136 |
125 |
$7K |
| D0180 |
|
158 |
120 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$2K |
| D0CP1 |
|
45 |
12 |
$0.00 |