| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
833 |
381 |
$579K |
| D1110 |
Prophylaxis - adult |
7,916 |
7,791 |
$384K |
| D0120 |
Periodic oral evaluation - established patient |
7,522 |
7,419 |
$159K |
| D0274 |
Bitewings - four radiographic images |
4,177 |
4,101 |
$133K |
| D2950 |
|
761 |
351 |
$116K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
138 |
79 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,639 |
5,405 |
$72K |
| D0330 |
Panoramic radiographic image |
1,732 |
1,655 |
$71K |
| D1120 |
Prophylaxis - child |
1,037 |
1,028 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,055 |
1,042 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,537 |
1,523 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
796 |
759 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,162 |
1,150 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,370 |
1,635 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
123 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
27 |
$7K |
| D4910 |
|
64 |
64 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
26 |
$3K |
| D1330 |
|
234 |
231 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$1K |
| D1999 |
|
2,950 |
2,638 |
$0.00 |