| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
882 |
474 |
$419K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,099 |
756 |
$141K |
| D2954 |
|
970 |
521 |
$101K |
| D4910 |
|
1,282 |
1,276 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
1,039 |
1,032 |
$66K |
| D1110 |
Prophylaxis - adult |
728 |
727 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
943 |
942 |
$61K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
94 |
71 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
858 |
857 |
$40K |
| D9430 |
|
1,054 |
1,006 |
$34K |
| D4341 |
|
454 |
125 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
783 |
424 |
$31K |
| D1120 |
Prophylaxis - child |
773 |
769 |
$31K |
| D0350 |
|
2,115 |
573 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
294 |
126 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,003 |
999 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,496 |
1,213 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
65 |
$9K |
| D0340 |
|
183 |
182 |
$9K |
| D2931 |
|
57 |
27 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
572 |
415 |
$7K |
| D3221 |
|
107 |
76 |
$7K |
| D1206 |
Topical application of fluoride varnish |
516 |
515 |
$7K |
| D0330 |
Panoramic radiographic image |
213 |
212 |
$6K |
| D0274 |
Bitewings - four radiographic images |
186 |
186 |
$4K |
| D0272 |
Bitewings - two radiographic images |
217 |
217 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$2K |