| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,336 |
913 |
$632K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
459 |
408 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,376 |
2,370 |
$157K |
| D2952 |
|
1,106 |
791 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,183 |
2,180 |
$104K |
| D9430 |
|
2,831 |
2,424 |
$90K |
| D3320 |
|
163 |
134 |
$59K |
| D1110 |
Prophylaxis - adult |
470 |
470 |
$41K |
| D1120 |
Prophylaxis - child |
374 |
373 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
146 |
76 |
$17K |
| D1206 |
Topical application of fluoride varnish |
961 |
959 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
118 |
118 |
$9K |
| D0330 |
Panoramic radiographic image |
305 |
305 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,246 |
716 |
$9K |
| D4341 |
|
98 |
26 |
$7K |
| D1351 |
Sealant - per tooth |
168 |
32 |
$6K |
| D0274 |
Bitewings - four radiographic images |
150 |
150 |
$3K |
| D1320 |
|
153 |
153 |
$3K |
| D4910 |
|
26 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$144.00 |