| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
630 |
375 |
$391K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,338 |
1,277 |
$316K |
| D1110 |
Prophylaxis - adult |
3,995 |
3,988 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
5,312 |
5,295 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,022 |
3,016 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,305 |
1,295 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,890 |
2,886 |
$86K |
| D4342 |
|
861 |
351 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
6,671 |
6,572 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,511 |
4,489 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
317 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
386 |
276 |
$63K |
| D2950 |
|
428 |
295 |
$57K |
| D4910 |
|
496 |
492 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
850 |
837 |
$29K |
| D1206 |
Topical application of fluoride varnish |
796 |
791 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
29 |
$7K |
| D1120 |
Prophylaxis - child |
185 |
184 |
$6K |