| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,292 |
592 |
$858K |
| D2950 |
|
1,257 |
598 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,027 |
397 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
740 |
432 |
$100K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
145 |
135 |
$94K |
| D0330 |
Panoramic radiographic image |
1,314 |
1,313 |
$70K |
| D4910 |
|
606 |
598 |
$49K |
| D1110 |
Prophylaxis - adult |
863 |
861 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
983 |
982 |
$41K |
| D2330 |
|
333 |
100 |
$34K |
| D0274 |
Bitewings - four radiographic images |
992 |
991 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
785 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
90 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
776 |
774 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
45 |
$10K |
| D4341 |
|
73 |
27 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
25 |
$7K |
| D3320 |
|
14 |
14 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
215 |
$3K |
| D0460 |
|
66 |
66 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$205.56 |