| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,034 |
393 |
$714K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
224 |
178 |
$160K |
| D1110 |
Prophylaxis - adult |
1,555 |
1,476 |
$79K |
| D2954 |
|
418 |
230 |
$78K |
| D0274 |
Bitewings - four radiographic images |
1,190 |
1,122 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
806 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
154 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,953 |
1,817 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,310 |
1,349 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
568 |
539 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
742 |
699 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
57 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
40 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
53 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
305 |
298 |
$6K |
| D0272 |
Bitewings - two radiographic images |
85 |
81 |
$1K |
| D1120 |
Prophylaxis - child |
23 |
19 |
$976.26 |