| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,328 |
977 |
$631K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
467 |
418 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,259 |
3,245 |
$215K |
| D0210 |
Intraoral - complete series of radiographic images |
2,781 |
2,766 |
$132K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
930 |
380 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,592 |
752 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,552 |
662 |
$83K |
| D4341 |
|
1,065 |
277 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
810 |
806 |
$62K |
| D1120 |
Prophylaxis - child |
1,251 |
1,243 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
777 |
414 |
$51K |
| D2140 |
|
848 |
401 |
$46K |
| D2952 |
|
352 |
233 |
$37K |
| D1110 |
Prophylaxis - adult |
414 |
410 |
$37K |
| D3320 |
|
94 |
84 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,981 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,288 |
1,257 |
$26K |
| D0274 |
Bitewings - four radiographic images |
803 |
799 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
118 |
$14K |
| D4910 |
|
170 |
170 |
$13K |
| D1351 |
Sealant - per tooth |
391 |
107 |
$10K |
| D0350 |
|
1,022 |
309 |
$10K |
| D2330 |
|
91 |
57 |
$7K |
| D2954 |
|
65 |
48 |
$7K |
| D2160 |
|
82 |
60 |
$7K |
| D3310 |
|
15 |
13 |
$5K |
| D4342 |
|
50 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
14 |
$2K |
| D9430 |
|
28 |
28 |
$896.00 |
| D3221 |
|
13 |
12 |
$819.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$144.00 |