| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
848 |
568 |
$580K |
| D1110 |
Prophylaxis - adult |
8,598 |
8,195 |
$444K |
| D0210 |
Intraoral - complete series of radiographic images |
3,010 |
2,876 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
7,763 |
7,425 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,684 |
1,181 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,383 |
2,263 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,589 |
2,311 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,725 |
3,533 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,702 |
2,641 |
$78K |
| D2950 |
|
474 |
367 |
$76K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
124 |
90 |
$68K |
| D1120 |
Prophylaxis - child |
1,279 |
1,231 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
770 |
522 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,720 |
2,432 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
192 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,740 |
1,026 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
76 |
$10K |
| D4342 |
|
95 |
38 |
$8K |
| D2954 |
|
40 |
38 |
$7K |
| D0274 |
Bitewings - four radiographic images |
81 |
81 |
$3K |
| D2394 |
|
25 |
17 |
$3K |