| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
603 |
319 |
$422K |
| D1110 |
Prophylaxis - adult |
3,265 |
3,179 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,078 |
528 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,567 |
2,504 |
$55K |
| D2950 |
|
303 |
180 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
650 |
414 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,177 |
1,143 |
$40K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
59 |
31 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
817 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
456 |
450 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,499 |
1,352 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
428 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
26 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
192 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
441 |
334 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
26 |
$2K |
| D9110 |
|
60 |
56 |
$2K |
| D3120 |
|
15 |
12 |
$528.00 |
| D1999 |
|
143 |
141 |
$0.00 |