| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
285 |
217 |
$98K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
86 |
79 |
$57K |
| D0330 |
Panoramic radiographic image |
1,018 |
1,010 |
$48K |
| D2950 |
|
504 |
379 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,618 |
1,585 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
327 |
190 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,661 |
1,618 |
$36K |
| D1110 |
Prophylaxis - adult |
715 |
699 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,088 |
2,021 |
$21K |
| D0274 |
Bitewings - four radiographic images |
498 |
489 |
$14K |
| D1206 |
Topical application of fluoride varnish |
598 |
596 |
$12K |
| D1120 |
Prophylaxis - child |
331 |
331 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
582 |
581 |
$10K |
| D3320 |
|
22 |
13 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
49 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
721 |
571 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
42 |
$6K |
| D9994 |
|
872 |
868 |
$5K |
| D4355 |
|
46 |
44 |
$4K |
| D4341 |
|
26 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
98 |
98 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
54 |
51 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
45 |
$1K |