| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,049 |
411 |
$722K |
| D1110 |
Prophylaxis - adult |
3,512 |
3,452 |
$186K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
179 |
92 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,756 |
3,673 |
$89K |
| D0274 |
Bitewings - four radiographic images |
1,520 |
1,489 |
$55K |
| D1120 |
Prophylaxis - child |
1,031 |
995 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,467 |
1,427 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
966 |
933 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,741 |
1,681 |
$26K |
| D2954 |
|
117 |
42 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
403 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
54 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
187 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
597 |
541 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
38 |
$7K |
| D2950 |
|
23 |
13 |
$4K |