| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
662 |
407 |
$354K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,534 |
802 |
$200K |
| D1110 |
Prophylaxis - adult |
1,896 |
1,876 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,654 |
1,622 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
385 |
255 |
$61K |
| D2950 |
|
451 |
310 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,406 |
1,395 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
416 |
411 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
885 |
875 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,959 |
1,918 |
$24K |
| D0274 |
Bitewings - four radiographic images |
538 |
530 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
78 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
819 |
813 |
$11K |
| D0330 |
Panoramic radiographic image |
105 |
92 |
$6K |
| D4910 |
|
65 |
65 |
$5K |
| D1120 |
Prophylaxis - child |
120 |
120 |
$4K |
| D1206 |
Topical application of fluoride varnish |
184 |
181 |
$3K |
| D0460 |
|
44 |
44 |
$1K |
| D0270 |
|
39 |
39 |
$491.40 |
| D0350 |
|
12 |
12 |
$303.10 |