| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
767 |
466 |
$363K |
| D4910 |
|
1,629 |
1,624 |
$123K |
| D1110 |
Prophylaxis - adult |
1,293 |
1,289 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
1,659 |
1,652 |
$96K |
| D2954 |
|
893 |
550 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,248 |
1,245 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,014 |
625 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,431 |
1,429 |
$66K |
| D9920 |
|
584 |
473 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,350 |
3,413 |
$44K |
| D0350 |
|
4,594 |
1,815 |
$43K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
86 |
67 |
$40K |
| D0330 |
Panoramic radiographic image |
1,162 |
1,157 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,593 |
2,582 |
$34K |
| D9430 |
|
970 |
920 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
446 |
298 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,245 |
1,968 |
$26K |
| D4341 |
|
306 |
81 |
$21K |
| D1120 |
Prophylaxis - child |
521 |
520 |
$19K |
| D2160 |
|
238 |
163 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
159 |
62 |
$19K |
| D2140 |
|
310 |
182 |
$17K |
| D0274 |
Bitewings - four radiographic images |
753 |
749 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
158 |
$14K |
| D2931 |
|
73 |
42 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
116 |
79 |
$9K |
| D3221 |
|
37 |
27 |
$2K |
| D1999 |
|
1,279 |
944 |
$1K |