| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
578 |
390 |
$322K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,124 |
719 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
516 |
373 |
$74K |
| D2950 |
|
504 |
381 |
$71K |
| D1110 |
Prophylaxis - adult |
1,136 |
1,123 |
$55K |
| D1120 |
Prophylaxis - child |
1,032 |
1,020 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,525 |
1,509 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
491 |
478 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
698 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,136 |
1,131 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
292 |
214 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
653 |
625 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,512 |
1,433 |
$23K |
| D0274 |
Bitewings - four radiographic images |
523 |
514 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
909 |
702 |
$8K |
| D2790 |
|
16 |
14 |
$8K |
| D2394 |
|
39 |
30 |
$5K |
| D4341 |
|
27 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
111 |
17 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$287.80 |