| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
316 |
180 |
$216K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
365 |
227 |
$193K |
| D1110 |
Prophylaxis - adult |
2,826 |
2,666 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
965 |
491 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,666 |
2,521 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,013 |
294 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,762 |
2,637 |
$62K |
| D0330 |
Panoramic radiographic image |
665 |
621 |
$36K |
| D9110 |
|
937 |
884 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,492 |
2,271 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,408 |
1,131 |
$22K |
| D1206 |
Topical application of fluoride varnish |
686 |
669 |
$18K |
| D1120 |
Prophylaxis - child |
346 |
336 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
411 |
$16K |
| D0272 |
Bitewings - two radiographic images |
318 |
307 |
$9K |
| D2954 |
|
38 |
25 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
12 |
$6K |
| D7311 |
|
30 |
15 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$528.00 |
| D0270 |
|
26 |
25 |
$274.00 |