| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
375 |
269 |
$224K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
868 |
459 |
$115K |
| D1110 |
Prophylaxis - adult |
2,246 |
2,207 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,199 |
1,179 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,178 |
2,145 |
$87K |
| D4342 |
|
851 |
271 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,296 |
2,254 |
$57K |
| D2950 |
|
345 |
243 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,338 |
1,307 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
204 |
125 |
$32K |
| D4341 |
|
113 |
36 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,954 |
1,911 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
388 |
379 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
50 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
498 |
489 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
50 |
$8K |
| D4910 |
|
69 |
67 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
56 |
$660.49 |