| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
188 |
154 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,298 |
724 |
$93K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,737 |
$85K |
| D0330 |
Panoramic radiographic image |
1,294 |
1,253 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,692 |
1,643 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,572 |
1,531 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,554 |
1,506 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
654 |
625 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
431 |
278 |
$24K |
| D1120 |
Prophylaxis - child |
496 |
484 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
172 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
223 |
$19K |
| D2950 |
|
132 |
116 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,012 |
1,884 |
$17K |
| D4342 |
|
163 |
71 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
710 |
680 |
$10K |
| D1351 |
Sealant - per tooth |
288 |
33 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,886 |
1,018 |
$9K |
| D1206 |
Topical application of fluoride varnish |
286 |
277 |
$6K |
| D4341 |
|
50 |
12 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$2K |
| D0431 |
|
204 |
201 |
$2K |
| D0270 |
|
12 |
12 |
$168.96 |