| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
883 |
439 |
$578K |
| D2950 |
|
911 |
464 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
541 |
290 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
445 |
232 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,766 |
2,633 |
$66K |
| D4342 |
|
637 |
259 |
$60K |
| D1110 |
Prophylaxis - adult |
932 |
875 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,218 |
1,138 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,843 |
2,604 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
703 |
678 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
255 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
488 |
477 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
282 |
260 |
$9K |
| D2394 |
|
21 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
121 |
103 |
$2K |
| D4910 |
|
13 |
12 |
$809.83 |