| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
404 |
228 |
$286K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
92 |
87 |
$70K |
| D1110 |
Prophylaxis - adult |
799 |
774 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
561 |
540 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
496 |
270 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
744 |
720 |
$32K |
| D2954 |
|
134 |
82 |
$25K |
| D4342 |
|
243 |
87 |
$21K |
| D3320 |
|
35 |
28 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
197 |
74 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
98 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
292 |
$12K |
| D0274 |
Bitewings - four radiographic images |
324 |
319 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
553 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
348 |
341 |
$8K |
| D2950 |
|
34 |
24 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
176 |
174 |
$5K |
| D1120 |
Prophylaxis - child |
83 |
81 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
157 |
$2K |