| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,936 |
1,692 |
$1.41M |
| D2740 |
Crown - porcelain/ceramic |
1,347 |
787 |
$983K |
| D3320 |
|
815 |
665 |
$458K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
296 |
166 |
$164K |
| D2950 |
|
986 |
668 |
$160K |
| D3310 |
|
265 |
141 |
$128K |
| D4342 |
|
1,284 |
504 |
$111K |
| D1110 |
Prophylaxis - adult |
2,023 |
1,999 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
2,870 |
2,838 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,008 |
1,981 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
4,406 |
4,323 |
$63K |
| D0330 |
Panoramic radiographic image |
1,361 |
1,314 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,099 |
2,087 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
976 |
946 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
354 |
231 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
181 |
114 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,065 |
1,959 |
$22K |
| D2954 |
|
109 |
56 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
547 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
81 |
$13K |
| D1120 |
Prophylaxis - child |
166 |
165 |
$9K |
| D4341 |
|
44 |
15 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$2K |