| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
168 |
102 |
$73K |
| D1110 |
Prophylaxis - adult |
2,580 |
2,545 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,913 |
1,894 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,288 |
1,215 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,831 |
1,809 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
384 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
959 |
946 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,151 |
1,141 |
$19K |
| D2335 |
|
269 |
145 |
$18K |
| D1352 |
|
2,373 |
287 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
236 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
3,558 |
3,183 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,293 |
1,276 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
231 |
152 |
$12K |
| D9920 |
|
869 |
868 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
847 |
842 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
25 |
13 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,493 |
2,173 |
$7K |
| D1120 |
Prophylaxis - child |
296 |
294 |
$7K |
| D2950 |
|
142 |
90 |
$7K |
| D9971 |
|
275 |
159 |
$4K |
| D1351 |
Sealant - per tooth |
500 |
52 |
$3K |
| D2394 |
|
56 |
43 |
$3K |
| D2330 |
|
32 |
24 |
$1K |
| D2332 |
|
42 |
25 |
$600.00 |
| D0602 |
|
50 |
50 |
$390.00 |
| D1320 |
|
25 |
25 |
$262.00 |
| D9911 |
|
250 |
80 |
$0.00 |