| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
867 |
477 |
$567K |
| D2950 |
|
615 |
390 |
$96K |
| D1110 |
Prophylaxis - adult |
1,858 |
1,709 |
$96K |
| D0274 |
Bitewings - four radiographic images |
1,770 |
1,628 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,341 |
2,180 |
$56K |
| D1120 |
Prophylaxis - child |
800 |
765 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
253 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
899 |
818 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,056 |
1,025 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
538 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
416 |
185 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
302 |
$22K |
| D1351 |
Sealant - per tooth |
348 |
94 |
$15K |
| D3120 |
|
404 |
244 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
56 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
557 |
$9K |
| D4341 |
|
65 |
24 |
$8K |
| D0272 |
Bitewings - two radiographic images |
224 |
216 |
$7K |
| D7311 |
|
32 |
17 |
$3K |
| D2954 |
|
17 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
30 |
26 |
$2K |