| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
730 |
387 |
$450K |
| D2950 |
|
564 |
311 |
$82K |
| D1110 |
Prophylaxis - adult |
1,336 |
1,200 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,358 |
1,233 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
317 |
153 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,963 |
1,774 |
$44K |
| D4342 |
|
680 |
185 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
201 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
549 |
204 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
838 |
709 |
$29K |
| D1120 |
Prophylaxis - child |
547 |
516 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
775 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
321 |
269 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
374 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
653 |
$10K |
| D7311 |
|
56 |
43 |
$6K |
| D0272 |
Bitewings - two radiographic images |
158 |
132 |
$4K |
| D7250 |
|
35 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
393 |
144 |
$3K |
| D2330 |
|
35 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |