| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
510 |
319 |
$344K |
| D2394 |
|
670 |
268 |
$117K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,916 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
372 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,668 |
2,667 |
$71K |
| D1120 |
Prophylaxis - child |
1,562 |
1,562 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
338 |
188 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
643 |
640 |
$46K |
| D2950 |
|
203 |
146 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
784 |
784 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,244 |
1,243 |
$29K |
| D0274 |
Bitewings - four radiographic images |
770 |
770 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,461 |
1,450 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
408 |
$19K |
| D1206 |
Topical application of fluoride varnish |
604 |
604 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,446 |
1,043 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
14 |
$4K |
| D2335 |
|
24 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$1K |