| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
968 |
606 |
$561K |
| D0350 |
|
6,606 |
3,217 |
$216K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,536 |
859 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
980 |
600 |
$162K |
| D2950 |
|
959 |
643 |
$126K |
| D0330 |
Panoramic radiographic image |
2,409 |
2,401 |
$125K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
527 |
305 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,317 |
2,214 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,632 |
1,624 |
$66K |
| D1110 |
Prophylaxis - adult |
1,252 |
1,248 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
565 |
310 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,972 |
1,967 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,241 |
1,240 |
$31K |
| D0460 |
|
897 |
776 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
701 |
700 |
$23K |
| D4910 |
|
256 |
256 |
$22K |
| D4342 |
|
190 |
54 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,296 |
1,266 |
$16K |
| D4341 |
|
34 |
12 |
$9K |
| D2394 |
|
38 |
24 |
$8K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$196.68 |