| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
792 |
524 |
$374K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,046 |
1,119 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,735 |
1,730 |
$114K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
240 |
225 |
$110K |
| D1110 |
Prophylaxis - adult |
1,171 |
1,156 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,723 |
1,720 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
904 |
901 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
749 |
504 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,005 |
541 |
$54K |
| D0350 |
|
2,483 |
1,151 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,890 |
907 |
$20K |
| D3320 |
|
45 |
39 |
$16K |
| D4341 |
|
221 |
83 |
$15K |
| D1120 |
Prophylaxis - child |
340 |
339 |
$15K |
| D0274 |
Bitewings - four radiographic images |
629 |
623 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
62 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
313 |
311 |
$4K |
| D1206 |
Topical application of fluoride varnish |
232 |
232 |
$4K |
| D2394 |
|
40 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
136 |
$2K |
| D2332 |
|
18 |
12 |
$1K |