| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
392 |
231 |
$186K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,181 |
910 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
1,995 |
1,989 |
$111K |
| D1110 |
Prophylaxis - adult |
1,059 |
1,054 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,485 |
1,481 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
768 |
368 |
$60K |
| D9430 |
|
1,683 |
1,603 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
830 |
$52K |
| D1120 |
Prophylaxis - child |
1,325 |
1,324 |
$48K |
| D4910 |
|
515 |
512 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,920 |
2,913 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
637 |
310 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,414 |
1,413 |
$29K |
| D2954 |
|
266 |
169 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,692 |
2,106 |
$27K |
| D4341 |
|
289 |
75 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,604 |
1,515 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
13 |
$7K |
| D0330 |
Panoramic radiographic image |
191 |
190 |
$5K |
| D2394 |
|
44 |
25 |
$3K |
| D2330 |
|
19 |
12 |
$1K |
| D0350 |
|
321 |
319 |
$6.00 |
| D1330 |
|
80 |
80 |
$0.00 |