| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
797 |
348 |
$544K |
| D1110 |
Prophylaxis - adult |
3,311 |
3,224 |
$172K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
275 |
116 |
$148K |
| D0220 |
Intraoral - periapical first radiographic image |
6,645 |
6,017 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,317 |
2,213 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
455 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,978 |
1,940 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,599 |
2,547 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,423 |
3,426 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
846 |
824 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
450 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,057 |
1,045 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
134 |
$27K |
| D1120 |
Prophylaxis - child |
399 |
395 |
$21K |
| D2954 |
|
102 |
64 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
88 |
$14K |
| D9110 |
|
131 |
118 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |