| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
225 |
138 |
$152K |
| D1110 |
Prophylaxis - adult |
682 |
641 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
424 |
383 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
603 |
$28K |
| D2950 |
|
128 |
72 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
52 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
127 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
116 |
$16K |
| D2332 |
|
123 |
25 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
88 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
183 |
181 |
$5K |
| D0274 |
Bitewings - four radiographic images |
92 |
91 |
$4K |
| D2394 |
|
30 |
19 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
101 |
$3K |
| D1120 |
Prophylaxis - child |
64 |
64 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
99 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
88 |
$1K |