| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
582 |
325 |
$383K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,002 |
991 |
$226K |
| D2950 |
|
593 |
351 |
$101K |
| D1110 |
Prophylaxis - adult |
1,709 |
1,703 |
$82K |
| D1120 |
Prophylaxis - child |
1,910 |
1,909 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
402 |
161 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,502 |
2,501 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,937 |
2,925 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
209 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
543 |
365 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,138 |
1,136 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,835 |
2,658 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,513 |
1,510 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
546 |
542 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
470 |
463 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,804 |
1,696 |
$15K |
| D1351 |
Sealant - per tooth |
388 |
123 |
$9K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$3K |
| D0180 |
|
68 |
68 |
$3K |
| D0272 |
Bitewings - two radiographic images |
117 |
117 |
$2K |
| D2331 |
|
17 |
12 |
$1K |