| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,122 |
595 |
$344K |
| D2950 |
|
1,187 |
623 |
$61K |
| D3320 |
|
275 |
204 |
$60K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
176 |
145 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,666 |
1,656 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
973 |
374 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,027 |
375 |
$42K |
| D1110 |
Prophylaxis - adult |
1,575 |
1,564 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
174 |
$24K |
| D2332 |
|
398 |
109 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
728 |
$20K |
| D1120 |
Prophylaxis - child |
929 |
925 |
$19K |
| D3310 |
|
115 |
74 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
583 |
579 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
457 |
198 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
795 |
758 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,806 |
1,795 |
$15K |
| D1351 |
Sealant - per tooth |
797 |
182 |
$15K |
| D1206 |
Topical application of fluoride varnish |
913 |
908 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,519 |
1,510 |
$13K |
| D2331 |
|
255 |
94 |
$13K |
| D4341 |
|
250 |
72 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,534 |
2,379 |
$10K |
| D5760 |
|
66 |
60 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,876 |
1,799 |
$5K |
| D0603 |
|
533 |
528 |
$5K |
| D7311 |
|
54 |
44 |
$4K |
| D0170 |
|
121 |
119 |
$2K |
| D5761 |
|
31 |
29 |
$2K |
| D7310 |
|
28 |
23 |
$2K |
| D9920 |
|
99 |
99 |
$2K |
| D5421 |
|
104 |
103 |
$759.00 |
| D0190 |
|
164 |
163 |
$690.00 |
| D5422 |
|
68 |
67 |
$484.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$255.00 |
| D9110 |
|
15 |
15 |
$150.00 |