| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,543 |
1,036 |
$918K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,258 |
1,493 |
$300K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,284 |
920 |
$205K |
| D1110 |
Prophylaxis - adult |
4,013 |
3,999 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,812 |
3,804 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
1,804 |
1,796 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
3,271 |
3,233 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,048 |
4,035 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
595 |
417 |
$92K |
| D2950 |
|
685 |
447 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,763 |
2,760 |
$80K |
| D4342 |
|
703 |
327 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,126 |
5,069 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
793 |
791 |
$21K |
| D2332 |
|
76 |
52 |
$11K |
| D2335 |
|
48 |
25 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
45 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
14 |
$5K |
| D2954 |
|
27 |
25 |
$4K |
| D2394 |
|
17 |
14 |
$3K |
| D0270 |
|
80 |
80 |
$1K |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$487.31 |