| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,701 |
1,283 |
$1.19M |
| D1110 |
Prophylaxis - adult |
7,778 |
7,417 |
$396K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
435 |
403 |
$307K |
| D2950 |
|
973 |
789 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
7,115 |
6,756 |
$155K |
| D0210 |
Intraoral - complete series of radiographic images |
2,145 |
2,111 |
$152K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
188 |
163 |
$105K |
| D0274 |
Bitewings - four radiographic images |
2,680 |
2,583 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,145 |
769 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
967 |
459 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,745 |
1,673 |
$69K |
| D3320 |
|
119 |
97 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
422 |
305 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,064 |
2,910 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,470 |
1,338 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
651 |
401 |
$38K |
| D1120 |
Prophylaxis - child |
691 |
587 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,167 |
1,027 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
286 |
$11K |
| D4341 |
|
75 |
25 |
$10K |
| D5212 |
|
14 |
13 |
$8K |
| D9110 |
|
174 |
169 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
43 |
$4K |
| D2954 |
|
20 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$3K |
| D2332 |
|
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
12 |
$2K |