| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,268 |
765 |
$875K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
287 |
255 |
$201K |
| D2950 |
|
583 |
366 |
$88K |
| D1110 |
Prophylaxis - adult |
1,559 |
1,478 |
$82K |
| D2954 |
|
369 |
301 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,664 |
1,523 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
633 |
280 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,456 |
1,383 |
$49K |
| D0330 |
Panoramic radiographic image |
916 |
865 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,367 |
2,920 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,116 |
1,066 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,489 |
1,719 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
337 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
38 |
$11K |
| D2332 |
|
46 |
15 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
40 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
65 |
$5K |
| D9110 |
|
76 |
65 |
$3K |
| D2330 |
|
27 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
48 |
$1K |