| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
1,007 |
684 |
$485K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,028 |
505 |
$124K |
| D2740 |
Crown - porcelain/ceramic |
215 |
129 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
550 |
281 |
$84K |
| D4341 |
|
752 |
208 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,208 |
1,180 |
$79K |
| D2954 |
|
841 |
546 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
903 |
882 |
$61K |
| D1110 |
Prophylaxis - adult |
928 |
908 |
$60K |
| D2950 |
|
214 |
134 |
$39K |
| D0350 |
|
708 |
693 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
567 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
875 |
853 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,225 |
1,147 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
57 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
389 |
383 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
77 |
$11K |
| D0274 |
Bitewings - four radiographic images |
303 |
297 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
454 |
439 |
$5K |