| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
322 |
194 |
$225K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
186 |
161 |
$151K |
| D2950 |
|
387 |
259 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
533 |
251 |
$48K |
| D3320 |
|
75 |
58 |
$46K |
| D1110 |
Prophylaxis - adult |
793 |
767 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
266 |
140 |
$37K |
| D0274 |
Bitewings - four radiographic images |
945 |
914 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
599 |
576 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
392 |
179 |
$23K |
| D4341 |
|
185 |
68 |
$23K |
| D0330 |
Panoramic radiographic image |
590 |
565 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
125 |
$14K |
| D3310 |
|
25 |
13 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
408 |
395 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
218 |
$9K |
| D1120 |
Prophylaxis - child |
178 |
171 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
62 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
194 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
183 |
$3K |