| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
985 |
571 |
$163K |
| D2740 |
Crown - porcelain/ceramic |
171 |
146 |
$115K |
| D1120 |
Prophylaxis - child |
2,256 |
2,256 |
$84K |
| D1110 |
Prophylaxis - adult |
1,592 |
1,592 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,969 |
2,969 |
$75K |
| D1206 |
Topical application of fluoride varnish |
1,907 |
1,907 |
$45K |
| D0330 |
Panoramic radiographic image |
657 |
657 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,659 |
2,630 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,277 |
1,277 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
213 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
564 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
560 |
555 |
$23K |
| D2950 |
|
133 |
112 |
$23K |
| D1351 |
Sealant - per tooth |
777 |
216 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
127 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,181 |
2,134 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
774 |
774 |
$16K |
| D0272 |
Bitewings - two radiographic images |
680 |
680 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
51 |
$12K |