| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
658 |
596 |
$313K |
| D1110 |
Prophylaxis - adult |
3,141 |
3,123 |
$277K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,886 |
3,863 |
$254K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
481 |
466 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
2,726 |
2,701 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
4,170 |
4,145 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,597 |
1,660 |
$173K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
339 |
299 |
$161K |
| D9430 |
|
4,290 |
4,099 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,792 |
1,137 |
$97K |
| D1120 |
Prophylaxis - child |
2,131 |
2,111 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,794 |
4,755 |
$68K |
| D3221 |
|
988 |
909 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
916 |
604 |
$52K |
| D3320 |
|
132 |
120 |
$48K |
| D2330 |
|
412 |
242 |
$31K |
| D2954 |
|
292 |
265 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,430 |
1,410 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,349 |
2,269 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,628 |
2,585 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
165 |
135 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
140 |
$13K |
| D4341 |
|
185 |
54 |
$13K |
| D3310 |
|
35 |
28 |
$11K |
| D0272 |
Bitewings - two radiographic images |
825 |
824 |
$10K |
| D2331 |
|
65 |
44 |
$5K |
| D1351 |
Sealant - per tooth |
90 |
32 |
$2K |
| D0350 |
|
181 |
93 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$712.50 |
| D9910 |
|
23 |
18 |
$60.20 |