| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,157 |
1,367 |
$1.03M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,930 |
3,918 |
$259K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
510 |
453 |
$234K |
| D1110 |
Prophylaxis - adult |
2,589 |
2,584 |
$225K |
| D0350 |
|
23,630 |
5,986 |
$218K |
| D0210 |
Intraoral - complete series of radiographic images |
3,520 |
3,508 |
$168K |
| D4341 |
|
1,797 |
478 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
1,533 |
1,532 |
$100K |
| D4910 |
|
1,236 |
1,230 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,367 |
3,665 |
$74K |
| D1120 |
Prophylaxis - child |
1,470 |
1,467 |
$67K |
| D3320 |
|
173 |
135 |
$63K |
| D9430 |
|
1,677 |
1,559 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,026 |
2,020 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,088 |
2,083 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
290 |
188 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,060 |
2,057 |
$27K |
| D2394 |
|
272 |
163 |
$23K |
| D4342 |
|
427 |
124 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,279 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
143 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
92 |
$12K |
| D1351 |
Sealant - per tooth |
122 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
87 |
87 |
$3K |