| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
771 |
290 |
$508K |
| D1110 |
Prophylaxis - adult |
2,163 |
2,047 |
$104K |
| D4341 |
|
616 |
198 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,338 |
2,191 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
4,701 |
4,027 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,677 |
2,530 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,572 |
3,554 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
792 |
738 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,302 |
1,221 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
661 |
180 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
251 |
105 |
$31K |
| D5212 |
|
38 |
37 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
743 |
692 |
$20K |
| D1120 |
Prophylaxis - child |
395 |
376 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
28 |
13 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
302 |
286 |
$12K |
| D9110 |
|
291 |
260 |
$11K |
| D7311 |
|
93 |
70 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
68 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
131 |
40 |
$9K |
| D5211 |
|
13 |
12 |
$6K |
| D2140 |
|
110 |
29 |
$6K |
| D1206 |
Topical application of fluoride varnish |
105 |
98 |
$3K |
| D1351 |
Sealant - per tooth |
88 |
15 |
$2K |