| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,630 |
1,066 |
$854K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
710 |
619 |
$390K |
| D2740 |
Crown - porcelain/ceramic |
568 |
306 |
$366K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,909 |
1,578 |
$150K |
| D3320 |
|
211 |
177 |
$101K |
| D1110 |
Prophylaxis - adult |
2,992 |
2,945 |
$92K |
| D2950 |
|
1,475 |
1,055 |
$84K |
| D3310 |
|
207 |
121 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,348 |
3,272 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
2,214 |
2,162 |
$74K |
| D4341 |
|
1,212 |
482 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,660 |
855 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
771 |
363 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,617 |
2,567 |
$51K |
| D4355 |
|
445 |
433 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
559 |
358 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
688 |
666 |
$27K |
| D2954 |
|
271 |
156 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,515 |
4,116 |
$17K |
| D0330 |
Panoramic radiographic image |
435 |
423 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,733 |
1,697 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,341 |
2,381 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
90 |
$8K |
| D4910 |
|
45 |
39 |
$3K |
| D1206 |
Topical application of fluoride varnish |
163 |
160 |
$3K |
| D1120 |
Prophylaxis - child |
156 |
154 |
$3K |
| D1330 |
|
37 |
35 |
$0.00 |