| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,074 |
675 |
$758K |
| D2950 |
|
1,335 |
938 |
$242K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
343 |
316 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,847 |
956 |
$213K |
| D4341 |
|
1,253 |
466 |
$199K |
| D0210 |
Intraoral - complete series of radiographic images |
2,203 |
2,192 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,341 |
3,338 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,249 |
613 |
$119K |
| D1110 |
Prophylaxis - adult |
2,407 |
2,406 |
$118K |
| D3320 |
|
145 |
121 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,501 |
3,908 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,275 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,630 |
1,628 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
371 |
278 |
$57K |
| D1120 |
Prophylaxis - child |
1,252 |
1,252 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,177 |
1,158 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,643 |
1,643 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
587 |
350 |
$37K |
| D2954 |
|
127 |
112 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
101 |
$22K |
| D4910 |
|
204 |
204 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,027 |
1,939 |
$19K |
| D1351 |
Sealant - per tooth |
393 |
95 |
$12K |
| D2791 |
|
15 |
13 |
$10K |
| D3310 |
|
21 |
13 |
$9K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$379.60 |