| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
536 |
366 |
$362K |
| D2950 |
|
506 |
390 |
$78K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
79 |
69 |
$63K |
| D1110 |
Prophylaxis - adult |
689 |
643 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
933 |
828 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
436 |
236 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
607 |
559 |
$22K |
| D0274 |
Bitewings - four radiographic images |
620 |
571 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,202 |
1,087 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
228 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
935 |
782 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
51 |
$7K |
| D4342 |
|
75 |
27 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
211 |
191 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
122 |
$4K |
| D1120 |
Prophylaxis - child |
70 |
66 |
$4K |