| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
286 |
193 |
$187K |
| D1110 |
Prophylaxis - adult |
697 |
680 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
461 |
234 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
334 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
455 |
440 |
$18K |
| D0274 |
Bitewings - four radiographic images |
453 |
438 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
119 |
74 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
346 |
$15K |
| D4342 |
|
156 |
57 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
541 |
528 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
781 |
751 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
121 |
$12K |
| D4341 |
|
111 |
42 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
548 |
435 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
218 |
210 |
$6K |
| D1120 |
Prophylaxis - child |
125 |
119 |
$6K |
| D1351 |
Sealant - per tooth |
135 |
27 |
$5K |
| D2950 |
|
18 |
16 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
16 |
$2K |
| D0270 |
|
149 |
144 |
$2K |