| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,596 |
907 |
$755K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
516 |
355 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,192 |
3,157 |
$210K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,759 |
831 |
$206K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
387 |
363 |
$179K |
| D4341 |
|
2,130 |
573 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,145 |
1,200 |
$144K |
| D2954 |
|
1,178 |
856 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
2,489 |
2,471 |
$116K |
| D1110 |
Prophylaxis - adult |
848 |
836 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,213 |
689 |
$66K |
| D3320 |
|
167 |
149 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
649 |
502 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
742 |
741 |
$51K |
| D1120 |
Prophylaxis - child |
749 |
739 |
$36K |
| D3310 |
|
93 |
53 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
437 |
177 |
$25K |
| D2331 |
|
305 |
187 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,128 |
1,113 |
$23K |
| D4342 |
|
471 |
140 |
$20K |
| D2330 |
|
152 |
75 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,499 |
860 |
$10K |
| D9430 |
|
230 |
223 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
548 |
$7K |
| D2332 |
|
65 |
41 |
$5K |
| D0350 |
|
105 |
27 |
$316.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |