| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
190 |
110 |
$140K |
| D1110 |
Prophylaxis - adult |
1,628 |
1,575 |
$87K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
129 |
65 |
$68K |
| D0274 |
Bitewings - four radiographic images |
902 |
879 |
$32K |
| D2950 |
|
196 |
133 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
666 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
741 |
718 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,819 |
1,731 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,032 |
1,008 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
126 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
170 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
901 |
746 |
$11K |
| D1206 |
Topical application of fluoride varnish |
256 |
252 |
$7K |
| D1120 |
Prophylaxis - child |
91 |
89 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
14 |
$3K |
| D3120 |
|
81 |
51 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
36 |
$1K |