| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,255 |
690 |
$593K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
346 |
287 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,245 |
2,241 |
$148K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
975 |
429 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,823 |
1,817 |
$86K |
| D3320 |
|
138 |
100 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
514 |
257 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
468 |
467 |
$34K |
| D1120 |
Prophylaxis - child |
391 |
390 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,393 |
591 |
$14K |
| D1110 |
Prophylaxis - adult |
156 |
156 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
730 |
727 |
$10K |
| D4342 |
|
224 |
68 |
$9K |
| D0274 |
Bitewings - four radiographic images |
407 |
406 |
$8K |
| D3310 |
|
25 |
12 |
$7K |
| D4341 |
|
98 |
26 |
$7K |
| D4910 |
|
101 |
101 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
59 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
38 |
$5K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$2K |
| D9430 |
|
53 |
53 |
$2K |