| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,329 |
643 |
$890K |
| D1110 |
Prophylaxis - adult |
2,870 |
2,765 |
$146K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
267 |
160 |
$145K |
| D2950 |
|
763 |
410 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
5,624 |
4,660 |
$80K |
| D9110 |
|
2,087 |
1,915 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,468 |
2,402 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,290 |
1,238 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,240 |
1,193 |
$43K |
| D2954 |
|
182 |
140 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,095 |
2,760 |
$33K |
| D2394 |
|
158 |
109 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
168 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
104 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
100 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
215 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
38 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
104 |
100 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$913.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$660.00 |