| Code | Description | Claims | Beneficiaries | Total Paid |
| D2740 |
Crown - porcelain/ceramic |
1,513 |
1,009 |
$897K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,428 |
3,030 |
$637K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,468 |
1,892 |
$310K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
510 |
494 |
$285K |
| D2950 |
|
1,559 |
1,141 |
$239K |
| D3320 |
|
506 |
463 |
$232K |
| D1110 |
Prophylaxis - adult |
3,917 |
3,909 |
$193K |
| D0140 |
Limited oral evaluation - problem focused |
4,194 |
4,015 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
2,628 |
2,485 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,848 |
3,838 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
8,932 |
8,259 |
$134K |
| D1120 |
Prophylaxis - child |
3,175 |
3,170 |
$132K |
| D4341 |
|
969 |
411 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
4,646 |
4,641 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,168 |
4,164 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
775 |
644 |
$109K |
| D1351 |
Sealant - per tooth |
3,397 |
509 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,073 |
694 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,410 |
4,759 |
$82K |
| D3310 |
|
194 |
123 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,630 |
2,624 |
$79K |
| D4342 |
|
794 |
319 |
$65K |
| D0330 |
Panoramic radiographic image |
645 |
643 |
$30K |
| D2332 |
|
173 |
125 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
84 |
$15K |
| D4910 |
|
206 |
206 |
$15K |
| D2331 |
|
137 |
116 |
$13K |
| D2330 |
|
114 |
69 |
$8K |
| D2954 |
|
18 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$1K |
| D2940 |
|
13 |
12 |
$933.76 |
| D0270 |
|
69 |
68 |
$824.94 |