| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
279 |
195 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
904 |
471 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
1,068 |
1,043 |
$41K |
| D1110 |
Prophylaxis - adult |
762 |
761 |
$39K |
| D2950 |
|
212 |
164 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,261 |
1,261 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
863 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
548 |
537 |
$33K |
| D1120 |
Prophylaxis - child |
635 |
635 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,644 |
1,607 |
$25K |
| D0274 |
Bitewings - four radiographic images |
449 |
448 |
$15K |
| D1206 |
Topical application of fluoride varnish |
403 |
403 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,163 |
654 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
67 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
39 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
37 |
$6K |
| D2954 |
|
18 |
14 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
158 |
$4K |
| D4355 |
|
12 |
12 |
$1K |