| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
429 |
273 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,401 |
827 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
599 |
346 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
394 |
272 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,216 |
1,979 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,012 |
2,775 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
478 |
329 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
984 |
963 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
915 |
915 |
$37K |
| D1110 |
Prophylaxis - adult |
681 |
681 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,446 |
1,443 |
$29K |
| D1120 |
Prophylaxis - child |
440 |
440 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
494 |
492 |
$13K |
| D0330 |
Panoramic radiographic image |
170 |
168 |
$8K |
| D2954 |
|
34 |
27 |
$7K |
| D2950 |
|
13 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
23 |
23 |
$710.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$700.00 |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$570.00 |