| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
638 |
459 |
$453K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,154 |
1,115 |
$184K |
| D1110 |
Prophylaxis - adult |
2,993 |
2,927 |
$162K |
| D0274 |
Bitewings - four radiographic images |
2,400 |
2,356 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,217 |
3,156 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
3,401 |
3,308 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,544 |
1,522 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,098 |
2,947 |
$43K |
| D1120 |
Prophylaxis - child |
806 |
793 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
777 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
455 |
444 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
27 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
137 |
81 |
$12K |
| D2950 |
|
51 |
41 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
128 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
50 |
$4K |
| D2331 |
|
19 |
13 |
$2K |