| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
974 |
629 |
$558K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,698 |
3,263 |
$542K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
961 |
864 |
$539K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,660 |
3,796 |
$500K |
| D2950 |
|
2,014 |
1,474 |
$312K |
| D1110 |
Prophylaxis - adult |
7,525 |
7,524 |
$303K |
| D3320 |
|
657 |
548 |
$291K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,970 |
2,330 |
$244K |
| D3310 |
|
511 |
308 |
$196K |
| D0274 |
Bitewings - four radiographic images |
7,653 |
7,652 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
7,316 |
7,315 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,536 |
5,535 |
$178K |
| D1120 |
Prophylaxis - child |
3,978 |
3,978 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,169 |
947 |
$154K |
| D0330 |
Panoramic radiographic image |
3,841 |
3,839 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,110 |
5,110 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
3,658 |
3,642 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
1,480 |
1,477 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
3,993 |
3,970 |
$53K |
| D2954 |
|
302 |
241 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,633 |
2,278 |
$44K |
| D2394 |
|
61 |
56 |
$7K |
| D2331 |
|
40 |
26 |
$4K |
| D2330 |
|
19 |
12 |
$1K |
| D0270 |
|
130 |
129 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$759.31 |