| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,805 |
948 |
$2.02M |
| D2751 |
Crown - porcelain fused to predominantly base metal |
332 |
123 |
$190K |
| D1110 |
Prophylaxis - adult |
1,373 |
1,369 |
$75K |
| D2954 |
|
371 |
222 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,069 |
348 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,339 |
1,328 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
723 |
287 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
976 |
967 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,090 |
2,062 |
$33K |
| D0274 |
Bitewings - four radiographic images |
788 |
788 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,774 |
1,350 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
873 |
872 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
259 |
$19K |
| D2330 |
|
147 |
59 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
278 |
277 |
$8K |
| D2394 |
|
78 |
36 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
27 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
38 |
$5K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
28 |
$4K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$3K |