| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
518 |
334 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,046 |
1,038 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
963 |
960 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
589 |
364 |
$39K |
| D2954 |
|
278 |
191 |
$29K |
| D4341 |
|
345 |
100 |
$24K |
| D9430 |
|
472 |
440 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,245 |
1,086 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
126 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
131 |
$14K |
| D4910 |
|
175 |
175 |
$13K |
| D1110 |
Prophylaxis - adult |
133 |
133 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
105 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
12 |
$7K |
| D3320 |
|
18 |
13 |
$6K |
| D1206 |
Topical application of fluoride varnish |
400 |
393 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
31 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
746 |
477 |
$3K |
| D2330 |
|
26 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$2K |
| D0330 |
Panoramic radiographic image |
53 |
49 |
$2K |
| D4342 |
|
27 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$577.50 |