| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,164 |
750 |
$535K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,487 |
2,468 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
2,647 |
2,621 |
$141K |
| D9430 |
|
3,089 |
2,911 |
$97K |
| D4341 |
|
1,412 |
384 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,378 |
4,668 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,142 |
604 |
$74K |
| D1110 |
Prophylaxis - adult |
673 |
667 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,207 |
1,190 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,487 |
2,466 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
463 |
230 |
$29K |
| D4910 |
|
267 |
263 |
$20K |
| D9110 |
|
288 |
252 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,333 |
1,287 |
$16K |
| D1120 |
Prophylaxis - child |
337 |
330 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
49 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
73 |
$7K |
| D2160 |
|
73 |
43 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
37 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
277 |
271 |
$2K |
| D2330 |
|
24 |
13 |
$2K |
| D3221 |
|
26 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$264.00 |