| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
252 |
161 |
$169K |
| D1110 |
Prophylaxis - adult |
2,390 |
2,306 |
$118K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
128 |
77 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,552 |
2,456 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
674 |
660 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,117 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
813 |
405 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,191 |
1,150 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,165 |
2,044 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
698 |
$26K |
| D1120 |
Prophylaxis - child |
571 |
545 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
906 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
366 |
220 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
64 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,035 |
942 |
$13K |
| D4342 |
|
123 |
54 |
$11K |
| D2950 |
|
43 |
28 |
$7K |
| D5212 |
|
14 |
13 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
24 |
$5K |
| D0180 |
|
110 |
103 |
$4K |
| D2335 |
|
21 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$941.00 |