| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,048 |
588 |
$499K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,632 |
2,627 |
$166K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
332 |
218 |
$158K |
| D2952 |
|
1,364 |
860 |
$142K |
| D1110 |
Prophylaxis - adult |
1,508 |
1,504 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
928 |
$109K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
197 |
180 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,480 |
3,652 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,259 |
1,257 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
753 |
477 |
$59K |
| D4341 |
|
658 |
191 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
690 |
351 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,908 |
2,903 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
640 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,353 |
1,300 |
$16K |
| D3320 |
|
33 |
28 |
$12K |
| D0350 |
|
1,124 |
569 |
$11K |
| D9110 |
|
147 |
140 |
$9K |
| D2330 |
|
102 |
50 |
$8K |
| D1120 |
Prophylaxis - child |
87 |
86 |
$3K |
| D4342 |
|
30 |
12 |
$1K |
| D2940 |
|
13 |
12 |
$819.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$157.00 |