| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
508 |
317 |
$342K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,603 |
724 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,259 |
626 |
$95K |
| D2950 |
|
577 |
365 |
$89K |
| D1110 |
Prophylaxis - adult |
1,694 |
1,418 |
$78K |
| D2331 |
|
603 |
341 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,439 |
1,270 |
$42K |
| D2332 |
|
338 |
179 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,013 |
$23K |
| D2335 |
|
122 |
72 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
284 |
$12K |
| D0330 |
Panoramic radiographic image |
322 |
299 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
197 |
$8K |
| D3348 |
|
13 |
12 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
55 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
190 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
155 |
135 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
33 |
$837.00 |
| D1120 |
Prophylaxis - child |
17 |
17 |
$715.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$440.00 |