| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
659 |
400 |
$313K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,271 |
1,271 |
$84K |
| D4341 |
|
683 |
177 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
100 |
95 |
$46K |
| D1110 |
Prophylaxis - adult |
484 |
484 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
857 |
857 |
$41K |
| D2954 |
|
343 |
219 |
$36K |
| D2783 |
|
75 |
50 |
$36K |
| D3348 |
|
75 |
60 |
$35K |
| D9430 |
|
776 |
673 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
200 |
114 |
$24K |
| D2952 |
|
176 |
101 |
$18K |
| D1320 |
|
839 |
839 |
$15K |
| D1206 |
Topical application of fluoride varnish |
501 |
501 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
65 |
$7K |
| D0350 |
|
643 |
236 |
$6K |
| D3221 |
|
93 |
80 |
$6K |
| D3320 |
|
15 |
13 |
$5K |
| D3347 |
|
13 |
12 |
$5K |
| D1120 |
Prophylaxis - child |
73 |
73 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
851 |
373 |
$3K |
| D4910 |
|
39 |
39 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$2K |
| D4342 |
|
37 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
94 |
$1K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$527.00 |
| D9951 |
|
12 |
12 |
$420.00 |
| D0270 |
|
72 |
71 |
$360.00 |