| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
677 |
533 |
$264K |
| D1110 |
Prophylaxis - adult |
4,606 |
4,557 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,636 |
3,607 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,376 |
929 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,669 |
4,632 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,346 |
2,278 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
7,427 |
6,935 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
821 |
518 |
$28K |
| D0274 |
Bitewings - four radiographic images |
2,136 |
2,122 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,781 |
5,018 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,295 |
1,281 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
868 |
857 |
$23K |
| D8670 |
Periodic orthodontic treatment visit |
514 |
427 |
$21K |
| D1351 |
Sealant - per tooth |
1,341 |
184 |
$20K |
| D1120 |
Prophylaxis - child |
680 |
671 |
$15K |
| D4341 |
|
321 |
131 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
16 |
$9K |
| D0330 |
Panoramic radiographic image |
373 |
370 |
$8K |
| D2954 |
|
120 |
100 |
$7K |
| D2950 |
|
86 |
69 |
$4K |
| D9110 |
|
324 |
319 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
54 |
$3K |
| D1206 |
Topical application of fluoride varnish |
142 |
142 |
$2K |
| D9920 |
|
81 |
76 |
$1K |
| D9310 |
|
78 |
77 |
$855.00 |
| D0170 |
|
28 |
26 |
$475.00 |
| D0270 |
|
122 |
116 |
$360.80 |
| D0272 |
Bitewings - two radiographic images |
43 |
40 |
$231.00 |
| D0603 |
|
12 |
12 |
$80.00 |
| D1330 |
|
128 |
110 |
$0.00 |