| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,395 |
1,024 |
$660K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
454 |
414 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,794 |
1,779 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,633 |
1,620 |
$78K |
| D2954 |
|
569 |
448 |
$59K |
| D0350 |
|
5,726 |
1,490 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
419 |
185 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
290 |
$41K |
| D3320 |
|
43 |
39 |
$16K |
| D3310 |
|
44 |
27 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
104 |
$12K |
| D2952 |
|
109 |
76 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
261 |
255 |
$4K |
| D4341 |
|
54 |
14 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$4K |
| D4910 |
|
42 |
42 |
$3K |
| D1120 |
Prophylaxis - child |
35 |
32 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
324 |
59 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$583.20 |