| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
194 |
124 |
$135K |
| D1110 |
Prophylaxis - adult |
2,616 |
2,530 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
303 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,263 |
1,222 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,056 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
588 |
566 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,729 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,169 |
2,006 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
656 |
594 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
397 |
204 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
187 |
64 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,456 |
1,254 |
$17K |
| D0330 |
Panoramic radiographic image |
276 |
264 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
13 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
235 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
29 |
$4K |
| D4342 |
|
36 |
15 |
$3K |
| D2950 |
|
19 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
44 |
41 |
$2K |
| D7311 |
|
17 |
12 |
$2K |