| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
972 |
687 |
$612K |
| D1110 |
Prophylaxis - adult |
2,805 |
2,627 |
$137K |
| D2954 |
|
481 |
351 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
628 |
363 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,366 |
2,221 |
$49K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
82 |
67 |
$44K |
| D0274 |
Bitewings - four radiographic images |
928 |
873 |
$31K |
| D9110 |
|
927 |
872 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,016 |
1,862 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
173 |
$22K |
| D2950 |
|
152 |
124 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
311 |
290 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
477 |
$18K |
| D3320 |
|
28 |
25 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
226 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
348 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
40 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
28 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
50 |
$1K |
| D1206 |
Topical application of fluoride varnish |
56 |
56 |
$1K |
| D1330 |
|
80 |
77 |
$70.00 |
| D1999 |
|
28 |
24 |
$0.00 |