| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,057 |
484 |
$754K |
| D1110 |
Prophylaxis - adult |
5,380 |
5,292 |
$302K |
| D2950 |
|
1,131 |
572 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,843 |
1,079 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
1,723 |
1,684 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
5,080 |
5,006 |
$122K |
| D0274 |
Bitewings - four radiographic images |
2,507 |
2,469 |
$91K |
| D1206 |
Topical application of fluoride varnish |
3,383 |
3,333 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,083 |
2,015 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,878 |
1,829 |
$81K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
97 |
52 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,472 |
2,425 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,456 |
3,352 |
$54K |
| D1120 |
Prophylaxis - child |
924 |
911 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
384 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
198 |
138 |
$19K |
| D0330 |
Panoramic radiographic image |
231 |
229 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
31 |
$11K |
| D4341 |
|
38 |
13 |
$5K |
| D9110 |
|
44 |
43 |
$2K |