| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
143 |
66 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
337 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
113 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
120 |
$23K |
| D1110 |
Prophylaxis - adult |
399 |
369 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
433 |
$18K |
| D1321 |
|
516 |
479 |
$13K |
| D1320 |
|
521 |
480 |
$13K |
| D0470 |
|
359 |
326 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
34 |
33 |
$9K |
| D2950 |
|
48 |
26 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
159 |
156 |
$5K |
| D0274 |
Bitewings - four radiographic images |
119 |
118 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
337 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
59 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
255 |
188 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
64 |
$2K |
| D1120 |
Prophylaxis - child |
49 |
43 |
$2K |