| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
819 |
512 |
$382K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,138 |
2,129 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
1,761 |
1,753 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,159 |
694 |
$76K |
| D9430 |
|
1,579 |
1,459 |
$50K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
109 |
98 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
406 |
228 |
$47K |
| D2954 |
|
456 |
322 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
802 |
429 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
583 |
575 |
$42K |
| D1110 |
Prophylaxis - adult |
342 |
341 |
$29K |
| D1120 |
Prophylaxis - child |
565 |
557 |
$27K |
| D4341 |
|
300 |
87 |
$20K |
| D1206 |
Topical application of fluoride varnish |
983 |
972 |
$15K |
| D3320 |
|
30 |
27 |
$11K |
| D0274 |
Bitewings - four radiographic images |
573 |
570 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
782 |
732 |
$9K |
| D4910 |
|
121 |
121 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,862 |
1,113 |
$8K |
| D0330 |
Panoramic radiographic image |
213 |
201 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
29 |
$5K |
| D4342 |
|
115 |
43 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
39 |
$4K |
| D2330 |
|
33 |
12 |
$3K |
| D2332 |
|
24 |
12 |
$2K |
| D2331 |
|
20 |
13 |
$2K |
| D0350 |
|
106 |
44 |
$1K |
| D1320 |
|
61 |
60 |
$1K |
| D0270 |
|
95 |
94 |
$460.00 |
| D1310 |
|
42 |
42 |
$0.00 |