| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,268 |
1,082 |
$747K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
637 |
469 |
$245K |
| D2750 |
|
781 |
412 |
$227K |
| D2954 |
|
2,189 |
1,176 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,277 |
495 |
$90K |
| D3320 |
|
313 |
223 |
$86K |
| D1110 |
Prophylaxis - adult |
2,015 |
1,840 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,259 |
687 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
1,548 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,985 |
1,829 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,058 |
940 |
$36K |
| D3310 |
|
172 |
63 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,142 |
1,074 |
$26K |
| D2950 |
|
757 |
315 |
$20K |
| D4355 |
|
167 |
144 |
$16K |
| D1120 |
Prophylaxis - child |
233 |
223 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,503 |
1,381 |
$7K |
| D0274 |
Bitewings - four radiographic images |
485 |
460 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,031 |
835 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
65 |
$4K |
| D4341 |
|
102 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
185 |
167 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
30 |
$3K |
| D2980 |
|
85 |
39 |
$483.00 |