| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,772 |
1,188 |
$839K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
821 |
779 |
$376K |
| D3320 |
|
503 |
433 |
$183K |
| D2952 |
|
1,522 |
1,054 |
$158K |
| D9430 |
|
4,771 |
3,821 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,752 |
1,043 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,747 |
1,738 |
$115K |
| D3310 |
|
348 |
216 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,825 |
1,817 |
$86K |
| D4910 |
|
838 |
830 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
746 |
501 |
$59K |
| D4341 |
|
833 |
248 |
$58K |
| D0350 |
|
7,004 |
1,896 |
$57K |
| D1110 |
Prophylaxis - adult |
579 |
572 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
410 |
405 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
478 |
286 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,585 |
1,437 |
$26K |
| D4342 |
|
593 |
170 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
62 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,008 |
996 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
886 |
$11K |
| D0274 |
Bitewings - four radiographic images |
479 |
473 |
$10K |
| D2331 |
|
52 |
31 |
$4K |
| D1120 |
Prophylaxis - child |
50 |
50 |
$3K |
| D2954 |
|
17 |
13 |
$2K |
| D2931 |
|
13 |
12 |
$2K |