| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
578 |
471 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,366 |
2,350 |
$154K |
| D1110 |
Prophylaxis - adult |
1,713 |
1,700 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,173 |
1,284 |
$144K |
| D9430 |
|
4,405 |
3,675 |
$139K |
| D0350 |
|
15,286 |
4,110 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
1,657 |
1,643 |
$126K |
| D4910 |
|
1,417 |
1,395 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,923 |
1,908 |
$90K |
| D1120 |
Prophylaxis - child |
1,612 |
1,597 |
$73K |
| D4341 |
|
983 |
272 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,251 |
3,453 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,121 |
698 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,373 |
3,345 |
$54K |
| D2954 |
|
511 |
424 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
423 |
320 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,597 |
1,579 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,436 |
2,108 |
$29K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
27 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
27 |
$13K |
| D0250 |
|
460 |
458 |
$10K |
| D1320 |
|
345 |
345 |
$5K |
| D0240 |
|
472 |
276 |
$4K |
| D0272 |
Bitewings - two radiographic images |
251 |
251 |
$3K |
| D1310 |
|
114 |
114 |
$2K |
| D4342 |
|
34 |
14 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D9110 |
|
12 |
12 |
$756.00 |
| D0602 |
|
105 |
105 |
$675.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$637.50 |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
13 |
$92.00 |
| D2999 |
|
35 |
16 |
$0.00 |