| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
304 |
185 |
$217K |
| D1110 |
Prophylaxis - adult |
3,782 |
3,599 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
4,737 |
4,542 |
$113K |
| D1120 |
Prophylaxis - child |
2,277 |
2,200 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,809 |
2,659 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,891 |
2,776 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
970 |
537 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,603 |
1,523 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
118 |
72 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,548 |
1,474 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
764 |
725 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
708 |
374 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,164 |
2,046 |
$33K |
| D2950 |
|
186 |
132 |
$29K |
| D4341 |
|
187 |
69 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
31 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
623 |
492 |
$8K |
| D1351 |
Sealant - per tooth |
213 |
53 |
$8K |
| D0272 |
Bitewings - two radiographic images |
120 |
120 |
$4K |
| D3120 |
|
90 |
63 |
$3K |
| D2954 |
|
13 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$1K |