| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
705 |
427 |
$481K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
512 |
436 |
$354K |
| D2950 |
|
989 |
716 |
$152K |
| D4342 |
|
1,820 |
584 |
$147K |
| D1110 |
Prophylaxis - adult |
1,900 |
1,739 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,373 |
588 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,151 |
1,037 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,848 |
1,659 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,751 |
1,574 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,451 |
2,206 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,035 |
$47K |
| D1120 |
Prophylaxis - child |
638 |
623 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
1,046 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
482 |
174 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
198 |
78 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,912 |
1,720 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
534 |
242 |
$27K |
| D4341 |
|
161 |
54 |
$20K |
| D1351 |
Sealant - per tooth |
462 |
123 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
911 |
715 |
$11K |
| D3120 |
|
503 |
156 |
$10K |
| D0272 |
Bitewings - two radiographic images |
164 |
161 |
$5K |
| D2332 |
|
162 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
32 |
30 |
$2K |