| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
3,603 |
2,679 |
$1.71M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,274 |
4,518 |
$1.21M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,165 |
2,012 |
$1.00M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,684 |
11,668 |
$770K |
| D3320 |
|
1,306 |
1,177 |
$476K |
| D2954 |
|
2,706 |
2,132 |
$282K |
| D0210 |
Intraoral - complete series of radiographic images |
4,936 |
4,932 |
$235K |
| D3310 |
|
676 |
512 |
$204K |
| D0330 |
Panoramic radiographic image |
6,669 |
6,570 |
$189K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45,546 |
9,028 |
$185K |
| D9430 |
|
5,388 |
5,253 |
$172K |
| D0274 |
Bitewings - four radiographic images |
6,526 |
6,509 |
$138K |
| D1110 |
Prophylaxis - adult |
1,421 |
1,419 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
1,386 |
1,383 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,038 |
354 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,007 |
2,004 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
155 |
$18K |
| D7230 |
|
60 |
43 |
$11K |
| D1120 |
Prophylaxis - child |
176 |
176 |
$8K |
| D0270 |
|
1,385 |
1,383 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
65 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
584 |
582 |
$6K |
| D2394 |
|
17 |
16 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$764.40 |