| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,066 |
857 |
$2.05M |
| D1110 |
Prophylaxis - adult |
2,733 |
2,733 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,229 |
3,228 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,458 |
2,458 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
712 |
458 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,955 |
1,954 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
399 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,875 |
1,872 |
$33K |
| D0330 |
Panoramic radiographic image |
1,071 |
1,071 |
$32K |
| D1120 |
Prophylaxis - child |
713 |
713 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,701 |
1,698 |
$24K |
| D1351 |
Sealant - per tooth |
135 |
104 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,099 |
1,099 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
78 |
$14K |
| D2332 |
|
93 |
55 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
1,376 |
1,375 |
$8K |
| D0272 |
Bitewings - two radiographic images |
205 |
205 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
14 |
$1K |