| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
380 |
323 |
$130K |
| D1120 |
Prophylaxis - child |
2,843 |
2,841 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,241 |
3,238 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,054 |
880 |
$84K |
| D1110 |
Prophylaxis - adult |
1,422 |
1,420 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
536 |
469 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,602 |
1,601 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,637 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
593 |
516 |
$30K |
| D2950 |
|
331 |
302 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
728 |
726 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
229 |
207 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
137 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
649 |
628 |
$12K |
| D0274 |
Bitewings - four radiographic images |
608 |
606 |
$12K |
| D0330 |
Panoramic radiographic image |
298 |
298 |
$8K |
| D0272 |
Bitewings - two radiographic images |
686 |
686 |
$7K |
| D4341 |
|
23 |
16 |
$6K |
| D2332 |
|
33 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
522 |
$3K |
| D1351 |
Sealant - per tooth |
16 |
12 |
$2K |