| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,338 |
859 |
$636K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,180 |
3,163 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,684 |
1,234 |
$179K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
288 |
231 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,257 |
1,015 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
2,466 |
2,450 |
$117K |
| D1110 |
Prophylaxis - adult |
970 |
957 |
$86K |
| D0350 |
|
8,131 |
2,145 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,037 |
1,024 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
611 |
269 |
$71K |
| D1120 |
Prophylaxis - child |
1,209 |
1,194 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
586 |
321 |
$47K |
| D3320 |
|
127 |
101 |
$46K |
| D2952 |
|
393 |
250 |
$41K |
| D2332 |
|
487 |
116 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,981 |
1,684 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,207 |
2,179 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,276 |
1,260 |
$27K |
| D4341 |
|
322 |
83 |
$23K |
| D2954 |
|
205 |
161 |
$21K |
| D2330 |
|
221 |
99 |
$18K |
| D2335 |
|
148 |
79 |
$18K |
| D2331 |
|
215 |
63 |
$17K |
| D1351 |
Sealant - per tooth |
358 |
99 |
$13K |
| D4910 |
|
131 |
131 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
39 |
$5K |
| D9430 |
|
130 |
115 |
$4K |
| D0272 |
Bitewings - two radiographic images |
147 |
147 |
$2K |