| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
729 |
460 |
$425K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,033 |
1,399 |
$400K |
| D1110 |
Prophylaxis - adult |
5,710 |
5,611 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
6,527 |
6,445 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
4,105 |
4,007 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,490 |
3,419 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
618 |
337 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
1,080 |
1,032 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,580 |
5,385 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,058 |
2,030 |
$64K |
| D2950 |
|
430 |
297 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
447 |
236 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
839 |
830 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
40 |
$11K |
| D4342 |
|
66 |
25 |
$6K |
| D1206 |
Topical application of fluoride varnish |
245 |
243 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |