| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
976 |
502 |
$644K |
| D1110 |
Prophylaxis - adult |
3,822 |
3,785 |
$210K |
| D2950 |
|
1,347 |
726 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
3,178 |
3,151 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
936 |
924 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,500 |
2,404 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
521 |
512 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
829 |
808 |
$32K |
| D0274 |
Bitewings - four radiographic images |
904 |
896 |
$32K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
38 |
$31K |
| D1206 |
Topical application of fluoride varnish |
761 |
751 |
$20K |
| D0330 |
Panoramic radiographic image |
339 |
338 |
$16K |
| D1120 |
Prophylaxis - child |
284 |
278 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
109 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
948 |
853 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
40 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
18 |
$4K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$352.00 |