| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,244 |
625 |
$822K |
| D2950 |
|
1,101 |
630 |
$169K |
| D1110 |
Prophylaxis - adult |
2,733 |
2,649 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,145 |
1,977 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,487 |
2,423 |
$92K |
| D1120 |
Prophylaxis - child |
1,812 |
1,744 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,282 |
3,201 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,607 |
2,522 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,098 |
1,016 |
$73K |
| D1351 |
Sealant - per tooth |
1,316 |
324 |
$54K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
82 |
41 |
$42K |
| D4342 |
|
504 |
150 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,063 |
981 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
237 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,627 |
1,543 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
167 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
76 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
895 |
751 |
$13K |
| D0272 |
Bitewings - two radiographic images |
391 |
385 |
$12K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$6K |
| D2394 |
|
24 |
15 |
$3K |
| D7311 |
|
15 |
13 |
$1K |