| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
441 |
275 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,479 |
703 |
$99K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
206 |
140 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,309 |
1,299 |
$87K |
| D2954 |
|
782 |
508 |
$82K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
142 |
122 |
$65K |
| D1120 |
Prophylaxis - child |
1,282 |
1,269 |
$65K |
| D9430 |
|
1,891 |
1,702 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
738 |
738 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
925 |
442 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
926 |
920 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,764 |
1,749 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
292 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
362 |
224 |
$29K |
| D1110 |
Prophylaxis - adult |
332 |
332 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,522 |
1,962 |
$27K |
| D0350 |
|
2,237 |
881 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,734 |
1,665 |
$21K |
| D1310 |
|
419 |
416 |
$19K |
| D3320 |
|
49 |
40 |
$18K |
| D4341 |
|
159 |
42 |
$11K |
| D1351 |
Sealant - per tooth |
259 |
83 |
$10K |
| D3310 |
|
28 |
15 |
$8K |
| D0330 |
Panoramic radiographic image |
218 |
217 |
$6K |
| D4910 |
|
79 |
79 |
$6K |
| D3221 |
|
93 |
66 |
$6K |
| D0274 |
Bitewings - four radiographic images |
238 |
238 |
$5K |
| D0603 |
|
335 |
335 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
69 |
$3K |
| D2330 |
|
25 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
160 |
160 |
$2K |