| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
487 |
394 |
$232K |
| D1110 |
Prophylaxis - adult |
1,418 |
1,414 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,823 |
1,078 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
1,503 |
1,485 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,657 |
1,654 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
926 |
647 |
$74K |
| D1120 |
Prophylaxis - child |
1,549 |
1,528 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,351 |
1,349 |
$64K |
| D9430 |
|
1,778 |
1,596 |
$57K |
| D2954 |
|
361 |
304 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,940 |
1,726 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,148 |
1,134 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,375 |
1,370 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
292 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,553 |
1,536 |
$23K |
| D0350 |
|
2,401 |
1,107 |
$22K |
| D1320 |
|
1,254 |
1,248 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,758 |
1,649 |
$21K |
| D4910 |
|
132 |
127 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
124 |
123 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$1K |