| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
392 |
279 |
$258K |
| D1110 |
Prophylaxis - adult |
5,007 |
4,771 |
$254K |
| D0274 |
Bitewings - four radiographic images |
4,235 |
4,034 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,595 |
906 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,862 |
4,580 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
5,866 |
5,413 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,820 |
1,778 |
$77K |
| D1120 |
Prophylaxis - child |
1,605 |
1,535 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,910 |
4,234 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,419 |
1,321 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
666 |
648 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,595 |
1,502 |
$44K |
| D2950 |
|
313 |
237 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
542 |
303 |
$32K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
36 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
193 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
43 |
$10K |
| D1351 |
Sealant - per tooth |
100 |
27 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
27 |
$3K |
| D1206 |
Topical application of fluoride varnish |
78 |
78 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
65 |
64 |
$2K |
| D2394 |
|
13 |
12 |
$2K |
| D0270 |
|
12 |
12 |
$156.00 |