| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
743 |
388 |
$541K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
622 |
390 |
$86K |
| D1110 |
Prophylaxis - adult |
1,131 |
1,127 |
$73K |
| D2950 |
|
493 |
281 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
483 |
327 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
101 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,224 |
1,219 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
423 |
423 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
729 |
725 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
445 |
$19K |
| D0274 |
Bitewings - four radiographic images |
509 |
506 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
820 |
804 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
45 |
$10K |
| D4342 |
|
44 |
17 |
$8K |
| D4341 |
|
28 |
12 |
$7K |
| D4910 |
|
75 |
75 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
208 |
208 |
$4K |
| D2331 |
|
21 |
15 |
$3K |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$2K |
| D4346 |
|
15 |
15 |
$704.25 |