| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,807 |
1,282 |
$1.10M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,420 |
1,064 |
$1.04M |
| D3320 |
|
1,097 |
670 |
$696K |
| D2750 |
|
1,557 |
676 |
$634K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,091 |
1,995 |
$520K |
| D1110 |
Prophylaxis - adult |
7,120 |
7,011 |
$450K |
| D3310 |
|
821 |
230 |
$440K |
| D2950 |
|
3,884 |
1,759 |
$328K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,813 |
4,715 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
8,138 |
7,998 |
$247K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,358 |
822 |
$227K |
| D1206 |
Topical application of fluoride varnish |
8,977 |
8,813 |
$225K |
| D0330 |
Panoramic radiographic image |
4,708 |
4,606 |
$207K |
| D0274 |
Bitewings - four radiographic images |
7,475 |
7,342 |
$173K |
| D1120 |
Prophylaxis - child |
2,458 |
2,408 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
1,816 |
1,736 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
6,354 |
5,773 |
$68K |
| D1351 |
Sealant - per tooth |
1,402 |
246 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,337 |
2,173 |
$41K |
| D1330 |
|
3,431 |
3,356 |
$21K |
| D3120 |
|
413 |
289 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
12 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
351 |
347 |
$8K |
| D4355 |
|
80 |
80 |
$8K |
| D4341 |
|
79 |
26 |
$7K |
| D4910 |
|
25 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
79 |
77 |
$1K |