| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
272 |
176 |
$179K |
| D1110 |
Prophylaxis - adult |
2,924 |
2,768 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,460 |
637 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,968 |
2,799 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
541 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,468 |
1,397 |
$58K |
| D1120 |
Prophylaxis - child |
996 |
977 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,069 |
1,025 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,255 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,751 |
2,592 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,279 |
1,234 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
150 |
$33K |
| D0330 |
Panoramic radiographic image |
456 |
419 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
350 |
332 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,773 |
1,492 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
26 |
$20K |
| D4342 |
|
129 |
54 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |