| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
295 |
208 |
$209K |
| D1110 |
Prophylaxis - adult |
1,727 |
1,698 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
901 |
891 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
798 |
492 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,291 |
1,275 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
667 |
205 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,063 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,167 |
2,072 |
$35K |
| D2954 |
|
164 |
118 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,215 |
1,193 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,853 |
1,703 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
344 |
236 |
$22K |
| D1120 |
Prophylaxis - child |
395 |
391 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
495 |
486 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
503 |
495 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
70 |
69 |
$2K |
| D2331 |
|
21 |
12 |
$2K |