| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,106 |
1,289 |
$995K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
535 |
468 |
$245K |
| D2954 |
|
1,855 |
1,232 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,982 |
1,975 |
$129K |
| D4341 |
|
1,759 |
487 |
$122K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,322 |
$117K |
| D4910 |
|
1,097 |
1,095 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,613 |
1,606 |
$77K |
| D3320 |
|
188 |
160 |
$67K |
| D9430 |
|
1,988 |
1,752 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
636 |
636 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
649 |
352 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
731 |
327 |
$39K |
| D3310 |
|
103 |
59 |
$31K |
| D0350 |
|
2,488 |
849 |
$23K |
| D1120 |
Prophylaxis - child |
431 |
431 |
$22K |
| D4342 |
|
490 |
161 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
172 |
97 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,069 |
1,063 |
$18K |
| D0330 |
Panoramic radiographic image |
595 |
595 |
$18K |
| D2330 |
|
226 |
80 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,111 |
1,111 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,925 |
1,352 |
$16K |
| D0274 |
Bitewings - four radiographic images |
649 |
648 |
$13K |
| D1320 |
|
515 |
514 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
609 |
$7K |
| D2940 |
|
52 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$2K |
| D9951 |
|
14 |
13 |
$455.00 |