| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
900 |
611 |
$621K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
442 |
391 |
$317K |
| D2950 |
|
970 |
673 |
$144K |
| D1110 |
Prophylaxis - adult |
2,342 |
2,212 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,526 |
835 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
1,630 |
1,521 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,487 |
2,322 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
807 |
372 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,518 |
1,387 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,367 |
1,285 |
$48K |
| D3320 |
|
80 |
53 |
$34K |
| D1120 |
Prophylaxis - child |
690 |
666 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,306 |
1,253 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,940 |
1,780 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
321 |
170 |
$22K |
| D4342 |
|
209 |
76 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
468 |
$14K |
| D1351 |
Sealant - per tooth |
208 |
49 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
38 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
281 |
222 |
$3K |
| D1206 |
Topical application of fluoride varnish |
128 |
123 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
106 |
101 |
$3K |