| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,438 |
1,706 |
$1.15M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,975 |
3,962 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
3,543 |
3,531 |
$251K |
| D1110 |
Prophylaxis - adult |
2,381 |
2,369 |
$210K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
393 |
374 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
3,698 |
3,684 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,311 |
1,226 |
$154K |
| D9430 |
|
4,758 |
4,315 |
$152K |
| D2954 |
|
1,438 |
1,161 |
$150K |
| D1120 |
Prophylaxis - child |
2,792 |
2,785 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,125 |
5,473 |
$103K |
| D4910 |
|
1,161 |
1,156 |
$88K |
| D1206 |
Topical application of fluoride varnish |
5,564 |
5,544 |
$80K |
| D4341 |
|
1,061 |
299 |
$74K |
| D1320 |
|
4,967 |
4,945 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,157 |
3,144 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
873 |
452 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
622 |
423 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,003 |
3,798 |
$48K |
| D2160 |
|
391 |
235 |
$31K |
| D4342 |
|
681 |
233 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
407 |
249 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
165 |
87 |
$20K |
| D1351 |
Sealant - per tooth |
243 |
79 |
$9K |
| D2330 |
|
93 |
52 |
$7K |
| D9910 |
|
137 |
107 |
$6K |
| D3320 |
|
13 |
12 |
$5K |
| D0350 |
|
213 |
71 |
$2K |
| D0272 |
Bitewings - two radiographic images |
140 |
140 |
$2K |
| D9951 |
|
16 |
12 |
$490.00 |