| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
525 |
342 |
$367K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,527 |
1,312 |
$280K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,491 |
888 |
$200K |
| D1110 |
Prophylaxis - adult |
2,391 |
2,387 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
1,045 |
1,032 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,601 |
1,544 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,057 |
2,051 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,302 |
1,297 |
$52K |
| D4341 |
|
302 |
114 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
360 |
182 |
$43K |
| D1120 |
Prophylaxis - child |
675 |
675 |
$28K |
| D0274 |
Bitewings - four radiographic images |
788 |
788 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
908 |
908 |
$22K |
| D2950 |
|
104 |
85 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
719 |
699 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
76 |
$8K |
| D4355 |
|
96 |
96 |
$8K |
| D1351 |
Sealant - per tooth |
201 |
28 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
198 |
$2K |
| D4910 |
|
28 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
56 |
56 |
$1K |
| D1999 |
|
27 |
19 |
$0.00 |