| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
790 |
666 |
$477K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,711 |
1,966 |
$473K |
| D4341 |
|
2,866 |
1,055 |
$452K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,688 |
1,097 |
$291K |
| D4910 |
|
2,972 |
2,902 |
$191K |
| D1110 |
Prophylaxis - adult |
3,581 |
3,480 |
$178K |
| D0274 |
Bitewings - four radiographic images |
4,637 |
4,503 |
$153K |
| D0330 |
Panoramic radiographic image |
2,517 |
2,444 |
$134K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
262 |
238 |
$130K |
| D4355 |
|
1,210 |
1,181 |
$97K |
| D1206 |
Topical application of fluoride varnish |
4,765 |
4,626 |
$94K |
| D2950 |
|
724 |
633 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,988 |
3,886 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,220 |
3,202 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,386 |
870 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,598 |
2,518 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
4,439 |
4,187 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
1,840 |
1,771 |
$61K |
| D9920 |
|
262 |
255 |
$14K |
| D2332 |
|
122 |
82 |
$14K |
| D0270 |
|
623 |
595 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
36 |
$9K |
| D2394 |
|
53 |
40 |
$9K |
| D0350 |
|
606 |
570 |
$6K |
| D2331 |
|
48 |
38 |
$4K |
| D2330 |
|
42 |
27 |
$3K |
| D3120 |
|
86 |
66 |
$3K |
| D0272 |
Bitewings - two radiographic images |
121 |
118 |
$2K |
| D2335 |
|
15 |
12 |
$2K |
| D1320 |
|
45 |
45 |
$2K |