| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
284 |
103 |
$241K |
| D2750 |
|
492 |
383 |
$239K |
| D4342 |
|
1,910 |
574 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,710 |
654 |
$172K |
| D2950 |
|
1,032 |
683 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
448 |
$119K |
| D4910 |
|
1,120 |
1,112 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
1,767 |
1,736 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,406 |
1,399 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,256 |
2,244 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
537 |
519 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,250 |
1,247 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,819 |
2,736 |
$35K |
| D1110 |
Prophylaxis - adult |
796 |
793 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
151 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
100 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,237 |
1,229 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
28 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
26 |
$6K |