| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
734 |
559 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,566 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,042 |
1,809 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,669 |
2,659 |
$175K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,674 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,055 |
2,045 |
$97K |
| D4910 |
|
1,285 |
1,268 |
$96K |
| D4341 |
|
892 |
297 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,705 |
3,184 |
$60K |
| D1120 |
Prophylaxis - child |
1,282 |
1,277 |
$57K |
| D1206 |
Topical application of fluoride varnish |
3,676 |
3,668 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,323 |
2,310 |
$49K |
| D0350 |
|
4,675 |
2,307 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
472 |
309 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
331 |
$27K |
| D9430 |
|
511 |
486 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
26 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
248 |
247 |
$3K |
| D2394 |
|
16 |
12 |
$1K |
| D1999 |
|
171 |
169 |
$46.00 |