| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
292 |
209 |
$214K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
577 |
$152K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
568 |
272 |
$116K |
| D1110 |
Prophylaxis - adult |
1,169 |
1,169 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,271 |
1,232 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,164 |
1,162 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
281 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
633 |
609 |
$48K |
| D1120 |
Prophylaxis - child |
1,148 |
1,148 |
$48K |
| D2950 |
|
280 |
227 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,259 |
2,225 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,763 |
1,762 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,258 |
1,258 |
$37K |
| D0330 |
Panoramic radiographic image |
562 |
557 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
114 |
$29K |
| D0274 |
Bitewings - four radiographic images |
784 |
783 |
$27K |
| D1351 |
Sealant - per tooth |
782 |
101 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,041 |
1,690 |
$22K |
| D7230 |
|
24 |
13 |
$9K |