| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,364 |
888 |
$353K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
487 |
416 |
$250K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,644 |
895 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,098 |
1,145 |
$133K |
| D1110 |
Prophylaxis - adult |
3,480 |
3,388 |
$118K |
| D2950 |
|
1,524 |
1,037 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
673 |
373 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,119 |
2,760 |
$68K |
| D4355 |
|
907 |
898 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
4,242 |
4,172 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,078 |
2,991 |
$59K |
| D3320 |
|
121 |
97 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
6,493 |
5,491 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,070 |
3,326 |
$47K |
| D1120 |
Prophylaxis - child |
1,558 |
1,545 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,469 |
2,429 |
$41K |
| D9610 |
|
3,196 |
2,903 |
$38K |
| D4910 |
|
1,040 |
1,027 |
$34K |
| D0330 |
Panoramic radiographic image |
696 |
625 |
$33K |
| D4341 |
|
636 |
237 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,824 |
1,627 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
2,440 |
1,010 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
239 |
$23K |
| D9630 |
|
1,374 |
1,349 |
$20K |
| D2394 |
|
78 |
60 |
$10K |
| D4342 |
|
146 |
56 |
$9K |
| D0272 |
Bitewings - two radiographic images |
90 |
90 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
103 |
$1K |
| D2332 |
|
36 |
24 |
$0.00 |
| D1999 |
|
302 |
220 |
$0.00 |