| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,529 |
622 |
$726K |
| D3348 |
|
222 |
183 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,507 |
1,502 |
$99K |
| D2954 |
|
910 |
456 |
$94K |
| D4341 |
|
1,027 |
270 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,420 |
1,414 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
128 |
112 |
$59K |
| D1110 |
Prophylaxis - adult |
673 |
670 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
353 |
257 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
622 |
411 |
$41K |
| D3347 |
|
96 |
72 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
217 |
$22K |
| D2952 |
|
189 |
98 |
$20K |
| D3320 |
|
50 |
43 |
$18K |
| D1206 |
Topical application of fluoride varnish |
621 |
621 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
77 |
$8K |
| D4910 |
|
68 |
68 |
$5K |
| D4342 |
|
83 |
24 |
$3K |
| D3221 |
|
27 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$975.80 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$525.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |