| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
656 |
346 |
$414K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,329 |
1,204 |
$309K |
| D1110 |
Prophylaxis - adult |
2,703 |
2,644 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
2,347 |
$98K |
| D2950 |
|
548 |
299 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
416 |
247 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,598 |
2,532 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
633 |
631 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,474 |
3,386 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,856 |
1,808 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
174 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
806 |
779 |
$28K |
| D0274 |
Bitewings - four radiographic images |
695 |
671 |
$21K |
| D2331 |
|
57 |
35 |
$7K |
| D1206 |
Topical application of fluoride varnish |
275 |
264 |
$5K |
| D1120 |
Prophylaxis - child |
81 |
80 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$292.36 |