| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
645 |
380 |
$303K |
| D2140 |
|
2,115 |
676 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,628 |
1,626 |
$104K |
| D1110 |
Prophylaxis - adult |
912 |
911 |
$79K |
| D2954 |
|
638 |
405 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,073 |
1,070 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
140 |
123 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,923 |
2,050 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,003 |
1,002 |
$48K |
| D1120 |
Prophylaxis - child |
1,195 |
1,192 |
$47K |
| D9430 |
|
1,044 |
961 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,504 |
2,498 |
$31K |
| D0350 |
|
2,900 |
786 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
370 |
203 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,696 |
1,691 |
$19K |
| D0330 |
Panoramic radiographic image |
642 |
632 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
60 |
$11K |
| D3320 |
|
15 |
12 |
$5K |
| D4341 |
|
45 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
129 |
$1K |